Toughing It Out: A Colonoscopy in Jerusalem

by Brian on January 13, 2014

in Health,Technology

Colon 2The waiting room in the gastro clinic at Shaarei Tzedek hospital is pleasant enough. Recently refurbished, there’s free WiFi, extra padded seats (a thoughtful touch given the nature of the work done there) and clean walls. The wall-mounted TV hums away, but not too loudly.

I was at Shaarei Tzedek as the “designated driver” for my wife, Jody, who, after more than a year of procrastination, supported by a surprising ambivalence by both our family doctor and several prominent anti-colonoscopy websites, finally decided to go ahead and do the deed dubbed the gold standard of cancer screening.

Indeed, the American Cancer Society recommends that basically everyone over the age of 50 undergo a colonoscopy every 10 years up until age 70 to rule out colon cancer which, because it grows so slowly, is one of the most treatable forms of cancer…if caught early enough. After age 70, in many cases, the scopes can stop because it’s more likely that something else will kill you before the colon cancer does. The Fight Colorectal Cancer advocacy group has more information.

So what’s the debate? It turns out that our kupat cholim (our HMO in Israel) has joined a growing medical chorus raising questions about the efficacy of colonoscopy. The reasoning is based on the fact that 3 out of every 1,000 colonoscopies has some kind of problem: excessive bleeding, a perforation of the intestinal wall and, in some cases (statistically not as rare as I’d imagined), even death.

According to this thinking, compared with the number of cancers caught, it might be safer not to undergo a colonoscopy and take one’s chances with the math. (The HMO is certainly also factoring in the financial cost to do the procedure and, if we were not living in Israel where socialized medicine covers 100% of the cost, this would be a consideration, too.) Or, as a compromise, do a shorter, faster “flexible sigmoidoscopy” – which is done in a regular doctor’s office, doesn’t check as much of the colon, but rarely results complications – every 3-5 years.

The sigmoidoscopy is done without anesthesia or sedation, which makes it safer (sedation carries its own set of risks) but is very uncomfortable. (I should know: as someone who suffers from Crohn’s Disease – thankfully in remission now for years – I’ve had more of these than I’d like to count as friends.) My report on the un-anesthetized pain of the sigmo, plus the realization that this “simpler” procedure is recommended as frequently as every three years after age 50, convinced Jody to opt for real deal.

When I last visited Shaarei Tzedek’s gastro department, it was for my own 50th birthday colonoscopy. The clinic was still under reconstruction then and I was shunted downstairs to my first stop – a dark supply closet stacked high with brown cardboard boxes filled with various liquids and equipment, where a gruff but efficient nurse hooked me up to the IV to administer the sedative – before being walked (not wheeled) next door to a spare Emergency Room for the procedure. (You can read my story about the experience here.)

Jody, by contrast, was escorted into a bright, airy space; a kind of “Let’s Make a Deal” anteroom with multiple doors to manage the 60 or so colonoscopies that Shaarei Tzedek does every single day. While she changed into something more comfortable to await the doctor, I settled into my chair. The procedure itself lasts about 30 minutes, followed by an hour or more of fuzzy recovery from the sedation. I’d brought a paperback, several eBooks, and a pile of podcasts on my iPhone, so I was ready for the long haul.

Imagine my shock when, exactly 30 minutes after I’d said goodbye to Jody, she walked into the waiting room on her own accord, entirely alert. I immediately assumed that the doctor had been unable to do the procedure; that the three days of pills and vile liquids and enemas had not cleaned her out sufficiently.

“I did it without tish-tush – sedation,” Jody announced with just enough flourish to capture my already rapt attention.

Say what?

“I was on the table with the IV already in my arm, and the doctor asked me, ‘Do you want it with sedation or without?’ I said to him, ‘What, I have a choice?’”

Now, Jody dislikes taking any kind of meds she can avoid, so the idea of doing the procedure au natural was enticing. She never took an epidural during labor. And, here was the colon-cherry on top of the… well, let’s leave that metaphor before it gets too gross – she would get a chance to watch along with the doctor on the TV monitor. “I’ve always wanted to see inside my body,” she said.

The doctor started, Jody squirmed but was transfixed enough by the video images to ignore the discomfort until one nasty turn pushed past her normally high pain tolerance. “Would you like that sedation now?” the doctor asked. “Yes,” Jody acceded. The nurse turned on the drip.

“Are you feeling groggy yet?” the doctor asked after a short time. “No,” Jody replied, “but the needle is stinging like crazy – it’s worse than the colonoscopy itself.” The doctor took a look.

“Nurse,” he said calmly, “the needle isn’t in her vein. It’s in a muscle.” He turned to Jody: “It’s only a little bit further. It will take longer to get the needle in. Do you think you can handle it?” Jody nodded.

And then it was over. An entire colonoscopy, a procedure which terrifies those who have never experienced it – and those who have – done in its entirety with no anesthesia. Jody – she’s da man. We drove home without delay and had an unexpectedly lucid lunch together.

Jody’s colon is fine by the way. Clean as a whistle. No polyps, no cancers. She’s good to go for another 10 years. By then, other technologies may make the traditional colonoscopy passé. The Israeli hi-tech pioneer Given Imaging’s PillCam already does wonders for visualizing the small intestine and bowel, replacing invasive procedures with a tiny camera you only need to swallow. The company’s latest product, PillCam Colon, promises to do the same for the rest of the digestive tract.

But given Jody’s positive experience in 2014, she might just opt for the “old fashioned” way again next time. And, to paraphrase the line made famous first in the movie “The Treasure of the Sierra Madre” and then again in “Blazing Saddles” – “sedation, we don’t need no stinkin’ sedation…”

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