The black snake


Have you read a wonderful item penned by American writer Dave Barry, the Pulitzer Prize-winning humor columnist for the Miami Herald, about his recent trip to his gastroenterologist for a colonoscopy? According to Dave, he was sure he was going to be attacked by 17,000 feet of garden hose inserted through his fundamental orifice.

If you haven’t read it, do a Google search, it is worth it. Serious laughter will result, but here are the final two paragraphs. “And then it was time, the moment I had been dreading for more than a decade. If you are squeamish, prepare yourself, because I am going to tell you, in explicit detail, exactly what it was like.

“I have no idea. Really. I slept through it. … The next moment, I was back in the other room, waking up in a very mellow mood. Andy (the gastroenterologist) was looking down at me and asking me how I felt. I felt excellent. I felt even more excellent when Andy told me that it was all over, and that my colon had passed with flying colors.

“I have never been prouder of an internal organ.”

So that was Dave Barry’s colonoscopy. After days of agonizing, it was a non-event, but what exactly is a colonoscopy?

A colonoscopy is test where the colonoscopist (a doctor who has specialized in the Gastro Intestinal system) looks into your colon, the large bowel. The last part of this tube leads into the rectum where the stool is stored before being passed out from the anus.

The instrument is called a colonoscope, and is a thin, flexible, fiber-optic tube with a small video camera at its head. This is sometimes called “the black snake” and is controlled by the colonoscopist who directs it up the rectum and into the colon, right around to the end of the small intestine.

The colonoscope also has a ‘side channel’ through which the colonoscopist can take tissue samples (biopsies) of any suspicious growths inside the colon.

A colonoscopy may be advised if you have symptoms such as bleeding from the anus, pains in the lower abdomen, persistent diarrhea, or other symptoms thought to be coming from the colon. The sort of conditions which can be confirmed include:

Ulcerative colitis (which causes inflammation of the colon).

Crohn’s disease (also causes inflammation of the colon).

Diverticula (pouches which form in the lining of the colon).

Polyps of the colon.

Cancer of the colon.

Various other conditions may also be detected, but probably one of the most important conditions is polyps, little grape-like growths which can turn cancerous if left for a long time.

There is also a rigorous preparation for a colonoscopy, which is designed to clean all the feces out of the colon before the procedure is done.

Incidentally, there is a procedure called a ‘virtual’ colonoscopy, by which a CT scan of the abdomen is converted into images of the inside of the colon. In the hands of experienced technicians and radiologists, the accuracy of this procedure has improved, but the ‘real’ colonoscopy is still the gold standard. By the way, the same preparation is also required, to ensure the colon is clean. It is also necessary to introduce air into the colon, via the anus, to be able to electronically ‘see’ the inside of the colon.

There is another similar procedure to regular colonoscopy called a gastroscopy, in which the fiber-optic tube is inserted via the mouth and then down into the stomach to allow a direct vision look at the upper gastrointestinal tract, and biopsies of suspicious ulcers and lesions can be taken at the same time. And no, Veronica, it isn’t the same black snake!

Having had a gastroscopy myself, I speak from personal experience, the only downside was gas. Since air is pumped in, that air has to get out somewhere. I compared the sensation to that of a rabbit being chased by a ferret around the burrow. You get gurglings right the way through to veritable abdominal explosions. As soon as you can, a trip to the toilet is in order.

And yes, we are geared up to carry out both upper and lower gastroscopies at Bangkok Hospital Pattaya.