Scott Webb (Host): Many people drag their feet on getting a colonoscopy because they've heard that the prep is not fun. But my guest today wants us to know that the prep isn't as bad as it used to be. And either way, it shouldn't stop folks from getting colonoscopies. And I'm joined today by Dr. Monzer Haque. He's a General Surgeon with Woodlawn Health.

 This is Woodlawn Health Doc Talk, a podcast from Woodlawn Health. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about colonoscopies, and I'm 55, so I've had two of them. And the prep definitely for the second one was better than the first one, and that's one of the things we're going to talk about is talk about the prep today.

And you know, there's a lot of, a lot of noise out there, things in the news, people may have heard from friends that the prep is really kind of a thing and kind of scary, but the truth is it probably isn't, and that's why you're here because you're the expert. So let's start there. What do people need to know about prepping for a colonoscopy?

Monzer Haque, MD: Yes, that is a true statement. In the past, preps used to be quite distasteful, a significantly large amount, and people significantly had nausea and vomiting in the past, and many of them could not tolerate the prep. And word got around, which made people reluctant to have the colonoscopy.

But in that regard, we have come a long way. We have some good flavors now. People can choose from a number of flavors. The volume has gone down. And, the other factor was, you know, people with different conditions, such as kidney conditions or heart conditions, could not take certain preps in the past, but we have many advanced preps that can be given to people with chronic liver conditions, kidney conditions, or heart conditions.

Host: Yeah, that was my experience. As you say, the volume has gone down significantly. It tastes a whole lot better. And I think one of the points we're trying to get across today is that the fear of prep or whatever people have heard, that is not a reason not to have a colonoscopy, especially now that there've been such advancements in the prep.

And let's talk about the work type thing. You know, I know like people are going to wonder, can they work the day before? Maybe can they work the day after? Take us through that. What about work, especially the day before?

Monzer Haque, MD: People absolutely can work the day before, but one of the things they have to remember is, you know, we put people on clear liquid diet, so folks have to make sure that they stay hydrated, and not just with water, but also with electrolytes, so, some kind of a sports drink that's sugar free or low on sugar is recommended. As long as they mind that and they can start taking the prep at an appropriate time at work, not everyone can do it, but if they can take the prep at work and have access to bathroom facilities. For certain folks it will not be possible, but a lot of folks can go to work the day before. But at the same time, you know, we are very, very cognizant of this and we are happy to give folks a letter, excusing them from the work, whatever they need, and we're happy to connect with their employer and arrange appropriate days off.

Host: Yeah, that's nice. Yeah, as you say, need access to bathroom facilities for sure. And of course, my experience, I rediscovered my love of Jello. I ate a lot of Jello leading up to my colonoscopies. So that was good. I forgot how much I love Jello. Wondering, what do we need to bring with us when we come to the facility, come to the hospital for the procedure? Is there anything special that we need to bring along with us?

Monzer Haque, MD: Actually, just yourself and a driver. Folks should be dressed in a comfortable manner. And no special, clothing item or anything is required. But we do ask that they bring a driver because they will receive sedation and they cannot be driving back home after the procedure. And also it's important to bring somebody who can have access to the medical record because after the procedure, we discuss what the findings and give the pictures and because of anesthesia, folks often cannot retain that information. So, it's good if we have some family member we can talk to.

Host: Yeah, that's great advice. I was going to ask you if we should bring a support person, and definitely the twilight that you're in, sort of afterwards, makes it a little difficult to recall some things and have that information top of mind. So, good to have somebody with us, as you say, who has access to our medical records or is knowledgeable about our medical history. Take us through the procedure itself, you know, maybe not in graphic details, but generally what happens during a colonoscopy.

Monzer Haque, MD: Actually, the prep for the procedure starts even before the patient enters the room. We have a holding area where a very competent nurse will assess the patient and the patient will be seen by myself, all the time, it will be me who will see the patient prior to the procedure, because it's my patient, and the anesthesia staff who will give the patient anesthesia.

That particular person himself or herself will see the patient, will do a risk assessment, will make updates to their records. And then the patient will be given certain medications. If they have anxiety, we can give patients medication to reduce the anxiety. The patient will be brought to the room. It's a very, very ambient atmosphere, we have good music, and the nurses are very, very supportive and compassionate.

So there will be a given sedation even prior to the procedure starts and they will be asleep when the procedure takes place. And we do our appropriate examination, insert the scope, and look at the interior walls of the colon in thorough detail. We make sure we reach all the way to the cecum, which is the beginning point of the colon, and endpoint of the colonoscopy.

We take numerous pictures and then we slowly come out and the patient is brought out of sedation, taken back to the holding area where they're given certain amount of fluids and they have to tolerate that. They have to come out of the anesthesia. There are very rigorous criteria after which the patient can be sent home and I personally go talk to the patient and their family member.

Give them the pictures and arrange for a follow up date. So it's a rather pleasant experience, actually.

Host: Yeah, as you say, right, it's one of those things, especially for all of us of a certain age. And I know that they've lowered the recommendations, right? I started at 50, but now they recommend some folks start at 45. Maybe we could just wrap up with that and then talk about the, when folks should be thinking about this or speaking with their providers about having that first colonoscopy.

Monzer Haque, MD: Sure. Now, this is a very important point you made. You mentioned that point a few minutes ago when you said that, you know, the prep should not discourage folks from colonoscopy. And I was thinking of making this point. You know, the incidence of colon cancer is on the rise, particularly among younger people, and then the more aggressive type of colon cancer is also on the rise, so the recommendation to have your first screening colonoscopy is no longer 50, it's now 45.

That means a completely asymptomatic person off the walk of life should seek colonoscopy at 45, not 50. And this is a person with no family history or any kind of genetic predisposition to colon cancer. It gets a bit more complicated if a patient has family history or any genetic propensity for colon cancer.

Without getting into too much detail, if they have any such thing, they should report to their primary care physician. And I'm also available. We have a number of doctors here who do colonoscopies and they can present and we will give them the appropriate suggestion.

Host: That's perfect. Yeah. As you say, family history, genetics, it's not just an age thing. It seems like it used to be just once you hit 50, have your colonoscopy. Now the other factors, as you say, genetics, family history, and some other things. So, great stuff today. Really educational. Thanks so much. You stay well.

Monzer Haque, MD: Thank you, sir. I appreciate your time.

Host: That was General Surgeon Dr. Monzer Haque with Woodlawn Health. For more information, please visit woodlawnhospital.org. That's woodlawnhospital.org. And if you found this podcast helpful, please share it on social media. I'm Scott Webb. Thanks for listening to Woodlawn Health Doc Talk, a podcast from Woodlawn Health.