Colonoscopy with Purg-Odan (Pico-Salax/Sodium Picosulfate)

As I’m writing this, it’s the morning of my prep day for my third colonoscopy (my first was seven years ago in 2010; my second was five years ago in 2012). Even though this isn’t a new experience for me, and last time went pretty well, I’m still a bit anxious. I’m not sure what time my appointments were previously–I suspect they were in the morning–but this time, it’s at 1:15 pm in the afternoon, so I’m a bit worried about going that long without food.


Background

I’m 27 years old, and I live in southern Ontario, Canada. I was diagnosed with Crohn’s disease about eight years ago, when I was 19 years old. I’m not currently on any medication for my Crohn’s, but I have been on imuran, entocort, and prednisone in the past. My Crohn’s currently appears to be in remission, but having recently come off the imuran due to low lymphocyte counts, I guess my doctor wanted to make sure everything still looks okay, and that’s why I’m having the colonoscopy.

I picked up the Dulcolax and Purg-Odan from the pharmacy a few weeks ago. I’d asked them if it was okay to pick it up so far in advance of my procedure, and they said it was fine because those medications can sit for a year and not expire.


Timeline

  • Monday morning: Eat a solid breakfast.
  • Monday, 4:30pm: Take 2 Dulcolax pills. Drink the first packet of bowel prep mixed with 150 ml of water.
  • Monday, 4:30pm-8:30pm: Drink an additional 1.5-2 litres of clear fluids.
  • Tuesday, 9:15am: Take 2 Dulcolax pills. Drink the second packet of bowel prep mixed with 150 ml of water.
  • Tuesday, 9:15am-10:15am: Drink an additional 1.5-2 litres of clear fluids.
  • Tuesday, 10:15am-1:15pm: Do not eat or drink anything.
  • Tuesday, 1:15pm-3:15pm or 4:15pm: Colonoscopy time.
  • Tuesday, remainder of the day: Rest.

Monday, 9:00 am: Breakfast

I had three scrambled eggs with ketchup, an apple, and about two cups of milk. On a normal day, I would just have the eggs and one cup of milk, but this has to last me for 30+ hours, so I ate a bit more than normal. I didn’t eat any differently the last few days.


Monday, 11:00 am: Getting hungry?

On a normal work day, I eat lunch about 5 hours after breakfast, so this is just a fake hunger because I know that I’m not allowed to eat anything. I distract myself by working on my websites and watching The Monkees, and the hunger goes away.


Monday, 2:30 pm: Getting hungry

I’m actually feeling a little bit hungrier now (right on schedule for lunch time), but it’s not that bad. On a normal weekend day, I might have a snack now, but maybe not a full lunch. I’ve been holding off drinking anything, because I know I’ll need to drink a lot later, but I figure I probably should have something. I have some orange popsicles (the worst flavour, but pink and purple ones are not allowed), but I’m saving those for later tonight, when I suspect I’ll be really hungry.


Monday, 3:30 pm: Rumbling

My stomach made a few noises and I had a slight pang of hunger, but it subsided quickly.

Ow. I think.
Now what?
There’s something wrong with my stomach.
It hurts?
It’s making noises.


Monday, 4:20 pm: First dose of dulcolax and purg-odan

Since I (still) haven’t learned how to swallow pills, I crushed the dulcolax tablets with my pill crusher and mixed it with a bit of water. As was the case last time, it had no taste whatsoever and was very easy to take. Even though I crushed the pills last time, I made sure to double check at the pharmacy that it would still be okay to crush them, and they said it wouldn’t be a problem.

I read the instructions included with the purg-odan, which informed me I wasn’t supposed to eat fresh fruits or raw vegetables for three days before the procedure. Oops. The pamphlet my doctor provided didn’t mention that, so I don’t think it will be a big deal. I think the apple was the only fruit/vegetable I’ve eaten in the last three days; I guess it was a good decision to eat mostly junk food this past weekend. The instructions also say:

PURG-ODAN® is presented as a white powder preparation packaged in sachets, with a great tasting orange flavour…

“Great tasting”. I had to laugh.

I mixed the purg-odan with cold water. It kind of fizzed and bubbled. I stirred it for 3 minutes as per the instructions. The instructions say to let it cool down, but the glass still felt cool to me, so I put it in the fridge for about a minute. When I drank it, it was still a bit warm. I’m very a very picky eater/drinker, and I really don’t like warm drinks. It wouldn’t have tasted half as bad if I had let it cool for longer, so I’ll mix it early tomorrow and maybe put it in the freezer for a few minutes.

The taste wasn’t great, but I’ve tasted worse. I had it all down in less than five minutes. I followed my advice from last time and took big gulps rather than small sips. I also alternated with gulps of (cold) apple juice. I had an orange popsicle waiting nearby to help get the taste out of my mouth once I was done, but since the purg-odan was orange flavoured, it didn’t help much. Although, the benefit of them both being orange flavoured is that later on, when I burped, I could pretend I was tasting the popsicle and not the prep.

Last time I had a colonoscopy, I wrote that I felt kind of nauseous after taking the prep, so I planned on lying down in bed with my iPad and watching Star Trek. I did feel a very tiny bit nauseous, but I don’t think it was as bad as it was last time. My plan was to get one bottle of water down before each episode was over.

The purg-odan instructions also say in bold, all-caps:

DO NOT DRINK JUST WATER ALONE.

If I hadn’t read that, I probably would have just drank water. I’ve recently started cutting back on sugar, and juice/gatorade/popsicles are all loaded with sugar, but I guess one day of it won’t be too bad.

Throughout most of the first episode (“Chain of Command, Part II”), I didn’t feel too great, but by the end of the DS9 two hour premiere, I was feeling pretty normal, and I even started doing stuff on my computer again. I’ve just felt very bloated and watery, and I’m not really hungry, but I wish I could bite into something solid.


Monday, 7:26 pm: Bathroom

I’ve had a few false alarms, going to the bathroom and just having gas. Lots of urinating since I’ve drank so much water. I finally had my first stool at 7:26 pm, almost three hours on the dot after I finished taking the prep. There was a lot of it. The stool felt very watery coming out, but it looked more solid. I went two more times in the next ten minutes.

I had a white jumbo freezie, since I need to have something other than water. I still don’t feel hungry really.


Monday night/Tuesday morning: Mostly quiet

After my first trip to the bathroom, there was nothing until I went to bed at 10:40 pm and rolled over onto my stomach. I only woke up to use the bathroom once at around 1:30 am. I think I woke up a few other times, but I didn’t really want to get out of bed, so I just ignored it and went back to sleep. I had to go to the bathroom again around 6:15 am, at which time I decided to wake up for the day.


Tuesday, 7:30 am: Second dose of dulcolax and purg-odan

The instructions said I should take my second dose at 9:15 am, but I knew I wouldn’t be able to drink four bottles of water in an hour, so I started about two hours early.

The dulcolax was easy, as before.

I mixed the purg-odan and put it in the freezer for about five minutes. When I took it out, the glass was frosty, but the drink was not really that much colder than it had been yesterday. I think putting an ice cube in it and stirring would be the best bet. It still only took about 5 minutes to drink all of it, again with sips of apple juice in between gulps and an orange popsicle nearby.

I don’t think I felt nauseous at all this morning; I laid down and watched the next two episodes of Deep Space 9, and now I’m writing this. I feel pretty good. I’m still not hungry, but I don’t feel like I’m going to want any more water for a long time.


Tuesday morning: Bathroom

My next trip to the bathroom was around 9:00 am. Each time I go, it’s been the same: a lot of it, feels very watery, looks kind of flaky, brownish yellow. Definitely not clear at all. I did think I saw a tiny speck of blood once, but that’s probably just because I’m wiping so much. And I’m very sore. It’s not as bad this morning as it was last night, even though I used baby wipes and didn’t go that often.

Around 9:50 am, I went to the bathroom again. There wasn’t as much as there was previously, but it seemed to be mostly yellow liquid with lots of yellow flakes. I’m pretty sure the yellow liquid is not urine, because every time I’ve gone just to urinate, it’s been pretty clear.

I finished my fourth bottle of water around 10:00 am. So, in all, I had:

Monday

  • four bottles of water (2 L)
  • 0.5 cup of apple juice
  • orange popsicle
  • white jumbo freezie

Tuesday

  • four bottles of water (2 L)
  • 1 cup of apple juice
  • orange popsicle

10:45 am: More yellow liquid, still some flakes, but not as much.

11:15 am: More yellow liquid, not very many flakes at all.


Tuesday, 1:15 pm: Arriving at the hospital

My dad drove me to the hospital. The pamphlet says you need to have someone there with you to accompany you home.

I checked in at patient registration where I received a wristband, some papers, and instructions to go to the endoscopy check-in area upstairs.

At the endoscopy check-in area, I took a number and sat down in the waiting room. A few minutes later, my number was called, and I handed over my papers. The woman there asked me a few simple questions, and then I went back to the waiting room. After a while, a man called my name. He spoke to my dad to make sure he would be there to pick me up after the procedure. The man told my dad he could take a walk as long as he’d be back by about 2:45 pm.

The man took me down the hallway and gave me a plastic bag with two hospital gowns in it. I was instructed to go in one of the change rooms and remove my clothes except for my socks and shoes, put on the first gown so it opens in the back and the second gown so it opens in the front like a housecoat, then put my own clothes in the plastic bag and keep the bag with me at all times. He showed me where the bathroom and the patient waiting room were.

There were maybe five or so other patients in the waiting room. There was also a TV and some children’s toys, probably some magazines as well, but I didn’t look around that much. After a while, a woman called my name. She asked me some more procedure-related questions (are you allergic to this/that/etc, when’s the last time you ate/drank, what’s your current weight, have you had any abdominal surgery).

Next, she took me to a small room where I would get the little doo-hickey for the IV put in. Whenever I’ve had bloodwork done while sitting up, I’ve always passed out, so when I saw there was only a chair and not a bed in the room, I asked if I would be able to lie down, or if the chair reclined. I told her I tend to pass out when I get bloodwork done. She said, “Well, don’t” and I laughed, but I was really thinking, “Well, that’s real helpful.” I sat in the chair and found it did lean back a bit, but I was still mostly upright. She started to put the IV into my right hand, but it wouldn’t go. This is a common problem for me; I have very small veins. She asked if I was going to pass out, and I said I was okay so far. As she started preparing to try again on the left hand, I told her I was starting to feel faint. I guess then she left and got another nurse, who adjusted the chair so that it leaned back much further. If I had known it could do that, I probably would have been fine. The second nurse said she was going to get a warm blanket, and they both left. It sounded like there was something else going on at the same time that needed their attention. By the time they got back, I was okay. I don’t think I ever passed out completely. At one point, the second nurse was looking at my hand trying to find a vein, and she told me she had a guy recently start crying when she put the IV in, and she thought he was joking, so she laughed, but he was really crying. I think the first nurse left and the second nurse was in and out of the room. At one point, the second nurse told me her “sharpshooter” had just arrived. A third nurse came in and asked what was going on, and I explained I tend to pass out when I get bloodwork done. She said they would put me on a stretcher and then put the IV in while I was lying down. That’s what happened to me last time I had a colonoscopy, but I think they decided to get the stretcher before I started feeling faint.

So they brought me a stretcher (or my “limo”, as the second nurse called it) and took me over to the recovery room. The third nurse put an IV in my left hand, but then she accidentally pulled the IV out. She apologized and said that was her worst nightmare, and it was the first time it ever happened to her. I laughed and said it was alright. These things happen. She tried again and said “oh no, my second worst nightmare”, although I’m not sure what she meant, because everything seemed fine to me. Everything worked that time.

Another nurse came over to check on me every once in a while. She adjusted the stretcher so I was sitting up a bit more. I noticed there was a clock, and it was 2:15 pm. I asked her where the bathroom was, since I was now in a different room, away from the bathroom I was originally supposed to use. She showed me where it was and cautioned me that the water in the hospital is brown, but they do actually clean the toilets. I regretted not bringing baby wipes with me, since the hospital toilet paper was very rough.

After a while, they wheeled a young man into the “room” next to me. I heard one of the nurses say “another IV?” From what I heard, it sounds like he might have passed out. I guess it was his first colonoscopy, and he seemed very nervous. The nurses were telling him they had good drugs, and he wouldn’t feel a thing. One of the nurses said she had three people today say to her after the procedure was done “endoscopy? What endoscopy?” He had his procedure done before me, and when they brought him back to recovery, he seemed in pretty good spirits considering he had just had a colonoscopy. He said he was awake the whole time, but that didn’t seem to have bothered him. He was in recovery for less than ten minutes, and shortly after he left, a nurse came by to wheel me over to get my procedure done. By that time, I think it was around 3:25 pm.


Tuesday, ~3:25 pm: The colonoscopy

My gastroenterologist was in the room along with another doctor and maybe a few other people. My gastro was telling the other doctor about my history and why I was getting the procedure done. I was instructed to roll over onto my left side, and someone took my glasses. My doctor said hello, asked how I was doing. I said great, no problems. She introduced the other doctor, and I don’t recall who exactly she said he was, but I got the impression maybe he was a student or a new doctor or a doctor from an exchange program, because it seemed like he was there to learn, although she also told me he knew what he was doing; it wasn’t like this was his first colonoscopy, and they just decided to use me as a test subject.

I guess they hooked up the IV to sedate me, because I felt my vision get a bit blurry. As was the case with both of my previous colonoscopies, I was awake for the whole thing. I watched on the video screen, but without my glasses, I couldn’t really see any details, which is probably a good thing. It seemed like there were still a lot of yellow bits in there. I think the other doctor, not my gastro doctor, did the actual procedure, but I couldn’t see what was going on behind me. It didn’t hurt at all. I think it took about 20 minutes. When it was over, the other doctor came over and gave me a thumbs up, and the only words I remember him saying were “good” and “great”.


Tuesday, ~3:45 pm: Recovery

Then, I was wheeled back to the recovery room. A nurse there told me that the doctor said everything looked good, so they didn’t do any biopsies. She gave me a paper with some information on it. I’m not allowed to drive, operate heavy machinery, drink alcohol, or make important legal decisions for 24 hours since I was sedated. It also tells me who to call if I experience any problems and when my next appointment with my doctor is.

I laid down for a little while until my dad showed up. Someone gave me my bag with my clothes in it and pulled the curtains closed so I could get changed. I don’t know how long I was in recovery, but it felt like only a minute. Earlier, it sounded like they were short on beds, so they might have been rushing me, but I felt fine, so it was okay. It could have been ten or fifteen minutes, because I remember looking at my dad’s watch in the elevator, and it was 4:04 pm.

Last time, I remember being told to lie on my left side to help expel extra gas, but there was no mention of that this time, and very little gas to speak of, even after I went home.


Tuesday, ~4:04 pm: Going home

All in all, it was a pretty easy day, except for the IV thing. My hands hurt a bit for the next few days, and now they’re a bit bruised and green and yellow and purple. I had a solid stool the next day around lunch time. I feel totally normal, and all is good.