The Colonoscopy - The Toilet is the Captain Now
Long Overdue
During my time in undergrad, my mom was diagnosed with early-stage colon cancer. I don’t remember much about how everything happened. I was out of state at college and have four very responsible sisters; therefore, I didn’t have to navigate any of my mom’s care. What was clear was that the cancer was caught early enough that Mommy just needed surgery to remove it and didn’t require any chemotherapy or radiation.
A year later, Mommy developed some kinks in her intestines, related to scar tissue formation, and needed a follow-up surgery to remediate that. Otherwise, she’s been fine. To this day Mommy will tell you she didn’t have no cancer and wholeheartedly rejects the premise that she did, but I never leave that out when doctors asks about my family history!
Whenever I mentioned my mom, I was consistently told that I needed to start my colonoscopy 10 years prior to the onset of my mother’s diagnosis. My first colonoscopy should have occurred at age 40. I knew this logically; but, despite the many years I have spent working in health programs and on health communications, I was still non-compliant. Even after Chadwick Boseman’s untimely death from colon cancer in 2020, at the age of 43, I still didn’t go to the doctor.
Fear is a mother of an emotion! I wasn’t even fearful of the actual colonoscopy, or the prospect of having cancer, I was fearful of the colonoscopy prep and flat out didn’t want to do it. By this point I had already had three different hysteroscopies to remove uterine polyps, and a bunion surgery on my right foot, so I wasn’t scared of dying from an anesthesia mishap. I drew the line at Milk of Magnesia! Having been chronically constipated as a child, the thought of drinking terrible liquids for the ultimate “cleaning out” bowel movement was traumatic.
Forty-five (45) is the age everyone, without a familial history of colon cancer, should have their first colonoscopy. My friend Haleema went in for her routine screening in March 2023 and found out she had Stage 1 colon cancer. Just like my mom, she needed minimal treatment and was fine. However, her diagnosis was the wake-up call I needed. I was almost five years overdue for my first colonoscopy and it was time to let go of my fear. I literally had years of gastroenterologist referrals in my filing cabinet, from multiple doctors, and set a goal of having a colonoscopy by the time I turned 45 in August.
The Colonoscopy Prep
I had heard many horror stories about the liquid you are supposed to drink prior to the procedure. I hate the feeling of being nauseous and try to avoid it, and vomiting, at all costs. I know I’m really sick if I’m throwing up. Instead of a liquid prep, I went with Sutab tablets. They entailed taking six tablets at two separate times, the first six the night before the procedure and the other six the day of the colonoscopy. Although those twelve horse tablets (they are large pills) cost me $60, they were the answer to my primary fear about the colonoscopy.
Once I found out pills were an option, I couldn’t even entertain the liquid prep from a cost savings perspective. I was complaining about the $60 to my pharmacist and he told me the liquid prep was much cheaper and I could go that route instead. A friend of mine was offered Sutab as an option for his prep, but it would have cost him more than $300 for the same 12 tablets! A different friend was not even given the pill option for her colonoscopy prep. Insurance in America stays fundamentally flawed. Access to options can be the difference between life and death, especially for Black and brown folks.
Let me tell you, Sutab was extremely effective. At one point I was like I might as well bring a blanket and pillow into my bathroom. The toilet was the captain for hours after the initial dose kicked in and then again shortly after I took the second dose on the day of the procedure. By the time I got to the surgery center, my intestinal track was exhausted, and so was I. At a certain point, all the fecal matter in your system should be a yellowish watery discharge that is, unfortunately, still determined to leave your body.
Even after I took my shower to be fresh for the surgeon, thinking everything had left my system, my bowels were like, “we got more liquid ma’am.” These glutes got a good workout on the car ride to the surgery center. I was so ready for the colonoscopy to be over. Unfortunately, the surgery center was running behind schedule, so I had to do more communing with their toilet. There is only so long your body can hold a clench. By the time I was wheeled back to get the anesthesia flowing, I was already falling asleep. I didn’t even need to count down for the anesthesiologist.
After Surgery
When I woke up from my surgery, I thought I was still in the pre-op area waiting for the colonoscopy. I could hear the people in the next bed talking and thought, “When are they going to roll be back? I’m over here just a napping.” Then I was like wait a minute, my booty feels greasy. I deduced that somebody had to have been back there. That was the only logical explanation, therefore I must have had my colonoscopy. I slowly started to remember talking to the anesthesiologist before the procedure. One of the nurses came by and confirmed my suspicion that surgery was over. After spending some time in recovery, my doctor dropped in to tell me he removed two small polyps, but he was sure there was nothing to worry about.
A few weeks later, I got a call from the doctors office saying the polyps removed were the type that can turn into cancer, but were not actually cancerous. According to the notes I took when I was on the phone with nurse preparing for this procedure, 50% of the people they scope have polyps and 50% of those people have cancerous polyps, but I still didn’t know what it meant for me to have polyps that had the potential to be cancerous but were not. I sought clarification.
The most common types of colon polyps are hyperplastic and adenomatous. The adenomas have the potential to become cancerous, while hyperplastic (or inflammatory polyps) have virtually no chance of becoming cancerous. As it was explained to me, the non-cancerous type can live in your colon forever and not give you any smoke, versus the adenomas will eventually turn into cancer. If you have a clean colonoscopy, and no family history, you can wait ten years until your next one. I need to have another colonoscopy in five years and Haleema will need one more frequently.
The Business of Healthcare
I’m glad I got my colonoscopy and that my adenomatous polyps were removed well before they could become an issue, but I still ended up paying $700 out-of-pocket in costs not covered by my health insurance! I spent three hours on the phone talking to the insurance company and my health plan’s broker, then another 30 minutes talking to the billing office at the surgery center to understand why my preventative healthcare was so expensive. Although I was at the age for a preventative colonoscopy, it became a diagnostic colonoscopy once those polyps left my body. This resource is great for a general understanding of preventative versus diagnostic colonoscopies.
One web resource stated it succinctly, “If you have a history of polyps or colon cancer, or you receive a positive result from another colon cancer screening test, your colonoscopy likely will be considered diagnostic. It can make financial sense to schedule a diagnostic colonoscopy after meeting your deductible.” The bottom line is preventative colonoscopies do not exist for those with a family history or if a polyp is removed. Insurance coding for preventative procedures transition to diagnostic coding for any of those variables.
I had not met my health insurance deductible for the plan year (the amount you have to pay before your insurance coverage starts). Therefore, in addition to paying the balance on my $1,000 deductible, I also had to cover co-insurance, my share of the payment made against a claim. That’s how I ended up with a $700 colonoscopy. Unfortunately, there is a very real financial disincentive to better health outcomes in America. Word to the wise, the surgery center will give you about four months before they turn into Rihanna, “Bitch Betta Have my Money.”
The surgery staff was really sweet though, so being salty in my soul was about the business of healthcare not caring about actual people, not about the care I received. In one of my conversations with the insurance company, I was like y’all just want people to die don’t you. That was after I got a $400 bill related to my annul physical. Insurance in America stays problematic. We need a system that is not focused on profits and actually cares about people’s health. To that end, I wish Andre 3000 would rap about his colonoscopy. I want beats about colonoscopy prep, cancer prevention, and free diagnostic and preventative colonoscopies for all.