BY CYNTHIA RAMNARACE
Evening News staff writer
Kay Perugi has a philosophy: "The more you know, the less you fear."
So when her doctor said it was time for her to get a colonoscopy, she didn't procrastinate. It won't be as bad as people say, she was told. She would be sedated for the procedure and would be able to take pills instead of the dreaded thick, briny solution commonly used to cleanse the colon.
Her preparation began a day before the procedure with an all-liquid diet. At 5 the night before, she started popping pills.
Visicol tablets are for those who, like Mrs. Peruji of LaSalle, can tolerate large pills. She had to take 28 pills. They were taken four at a time in 15-minute intervals. She didn't get nauseous or experience painful cramping as she had feared. Within an hour after her last pill, "everything started flushing out," she says.
That is the point of either Visicol or the briny solutions called NuLYTELY and GoLYTELY. The colon needs to be cleared out in order for the doctor to search every nook and cranny for polyps, hemorrhoids and other symptoms of disease.
Visicol has made things much easier for patients, said Susan Manor, certified gastroenterology registered nurse and clinical manager of The Surgery Center. She described the liquid formulas as similar to "drinking ocean water" and said there are many patients who can't tolerate the taste and experience vomiting.
At 8 a.m. Mrs. Perugi, a teacher in Woodhaven, was at The Surgery Center. She underwent conscious sedation, where she could hear what is going on and respond to questions but was completely relaxed and numb to what the doctor was doing.
Gastroenterologist Dr. Murthy Madhira says the patient feels a little pressure, but because of the sedatives has little memory of it once she awakens.
Dr. Madhira inserted the endoscopic tube inside Mrs. Peruji's anus. On the tube is a light and small camera that transmits enlarged images to a nearby TV screen. Dr. Madhira skillfully maneuvered up the descending colon, through the transverse colon and then down the ascending colon. Getting around the curves can be difficult and requires some help from the nurses.
"Sometimes we need additional pressure, so (gastroenterology assistant) Cyndi (Helms) is going to give you a hug," endoscopic nurse Elizabeth Lommerse told Mrs. Perugi. She nodded, and Ms. Helms, a licensed practical nurse, pressed against Mrs. Perugi's stomach.
Dr. Madhira was looking for anything out of the ordinary. A healthy colon is pink and smooth. When he sees a polyp, sort of a pimple on the colon, or small pockets called diverticulosis, he takes a picture.
A polyp will be removed immediately, if it is small, but Mrs. Peruji had none. Larger polyps require surgery. She does have some diverticulosis pockets, but those are common. They can become problematic because things like seeds or corn kernels can get stuck in them, causing inflammation. Diverticulosis pockets can lead to diverticulitis, Crohn's disease or colitis.
"Nobody knows why they form," Dr. Madhira said. "Some say it's because of not eating enough fiber or eating seeds, popcorn or nuts, but there are no studies that say that's the cause of it."
Within 30 minutes, the scan was done and the endoscope removed. Mrs. Perugi had a good scan. No polyps and some diverticulosis and hemorrhoids but nothing out of the ordinary. Because she doesn't have a family history of colon cancer and no polyps were found, she won't need to go through this again for another 10 years, Dr. Madhira says.
Most colonoscopies are just like Mrs. Perugi's n normal. About 40 percent of the time Dr. Madhira will find polyps, which are precancerous growths.
"The basic idea is to removed polyps, so we remove cancer," he said. "If it grows more than 2 centimeters, that increases the chance of it becoming cancer."
Mrs. Peruji was in recovery for half an hour, and by 9:30 a.m. she was home. She felt a little discomfort, but not much, and remembers nearly nothing of the procedure.
"I remember a little pressure on the abdomen, but it meant nothing to me," she said. "I was very comfortable."
The greatest sense of relief came from knowing there was nothing wrong. And now she's more prepared for her next colonoscopy.
"Now I know what it's like, so I won't worry about it next time," Mrs. Perugi says.
Colonscopies are recommended for everyone once they reach 50. But there are other special circumstances that should lead a younger patient to request one.
"People shouldn't write off bleeding," said Susan Manor, certified
gastroenterology registered nurse and clinical manager of the
Rectal bleeding.
Any change in bowel habits.
Chronic constipation or diarrhea
Decreased stool size.
Family history of colon cancer. In those cases, screening should begin 10 years prior to the age that family member was when he or she was diagnosed.
A family history of hereditary colorectal cancer syndromes, such as familial adenomatous polyposis.
A personal history of colorectal cancer or irritable bowel disease.
To find out if you should receive a colonoscopy, see your doctor for a check-up.
Copyright The