Sometimes, you just have to say no. Maybe you’ve been feeling it “in your gut” for a few days, or even a few weeks, when there’s something you’re scheduled to do but something doesn’t seem right. I was going through one of these feelings big time on Monday, about a medical procedure I’m supposed to do every ten years. An inconvenient procedure that involves a long, unpleasant prep. Usually, I’d just grit my teeth and get done with a colonoscopy, but- –
With a what?
Close your ears, 9, if you hate needles you would really hate knowing about this. You, too, Lily. When you face it the first time at forty-six, it will be soon enough.
Fine by me. I’d much rather work on Viola’s monologue from Twelfth Night than travel down a medical procedure rabbit hole.
Well, yeah, me too. But since I’ve brought it up. . .
I’m guessing anyone over fifty who is reading this blog is familiar with the subject, maybe not the actual experience but some doctor or other has probably mentioned it to you at an annual exam. This would have been my third time around, 10 years since the last one- -I’d had no issues. But one of my health care providers flagged it last fall and referred me to the gastroenterology department because they were booking ten months out. I did the intake appointment soon after and received a prep sheet at that time.
Six months later, I learned my A1c was in the prediabetic range. This required a dietary realignment that resulted in weight loss. Good for most people, right? But not for me, because I am underweight. I am supposed to be gaining weight to build better bone density. When I consulted a nutritionist he suggested I really lean into nuts and seeds, highly caloric foods that are monounsaturated fats with few or no carbs.
Easy to do. Almonds in the oatmeal, peanut butter for a snack, etc. That, plus lots of olive oil and avocado, stopped the weight loss and it’s just started to turn around. Just in time for colonoscopy prep, for which you must stop eating nuts and seeds five days before the procedure. Worse yet, the allowed foods tend to be high carb and. . .Five days without nuts? I had an extremely hard time wrapping my head around how I was going to do this prep without dropping five or six pounds and, at 5’ 8” going into the procedure a literal 104 pound weakling. How long would it take me to recover from that?
Saying no: Instructions for an unpleasant procedure that, as it turned out, lacked full information. . .
Epiphany in the wee hours of Monday morning: I always buy chunky peanut butter, but surely creamy peanut butter would be allowed?
At 8 AM I called gastroenterology with that question, plus a couple more about prep, which I would need to start in 2 days. When I asked the pleasant-voiced receptionist about creamy peanut butter I could almost hear her wrinkling her (as I imagined it) button nose and saying “No, we recommend absolutely nothing that contains nuts.”
There was no other mention of food on the prep sheet I’d received last fall until the “day before” clear liquid fast. I remembered from prior experiences that there was a prohibition against any red, purple or blue foods at some point in the process, and asked about that. I mentioned tomatoes, strawberries, and red cabbage as examples. She said, “Those are all fresh fruits and vegetables that you need to stop 5 days before the procedure.”
“Really?” I said. “That’s not on my instruction sheet.”
I could almost hear her (as I imagined it) perfectly lipsticked mouth drop open. She said she’d send me a new one, which she did.
Saying no: Eleventh hour issuance of “new” instruction sheet, and only because I’d asked a few questions!
Raw fruits and vegetables weren’t the only items missing. If I’d been taking the medications that needed to stop 2 weeks before the procedure, I would have been a week behind already. A huge wave of disgust rolled over me. What if I’d relied on the old prep sheet, stopped nuts and seeds at my certain peril, continued to eat raw fruits and vegetables, done the 24-hour liquid fast and the downed the huge volume of loathsome Golytely prep liquid with the subsequent intestinal fireworks, only to show up at my procedure and be told, “Those are the wrong instructions. Here are the correct ones. Do the prep again and come back in two weeks.”?
Are you done yet? My hands are about to give out from covering my ears.
Almost there, 9!
The prep sheet wasn’t the first miscue I’d had from this department. When I’d found out about the prediabetes thing I’d emailed and asked if they had some sort of alternate prep for underweight people who can’t afford weight loss, and can’t do a lot of carbs. The department’s nurse practitioner replied it would just be loss of water and stool, not actual weight loss. Yeah, right. The next email I saw about him was a notification that he was leaving the department and going to work elsewhere.
Shortly after that, my original procedure date of June 2nd was moved to June 22nd because the surgeon had changed his colonoscopy schedule from “Tuesdays only” to “Mondays only”. I got a call not long after that informing me that my procedure was now scheduled for July 13. In all of this, I never did get a text from the pharmacy that my prep kit was ready for pickup. I called gastro two or three times to get that set in motion.
The prep sheet screw-up was merely the last in a long chain of red flags. I was extremely upset and angry Monday morning, couldn’t figure out what to do. So I went to the Y and did my routine Monday strength training, which went extraordinarily well as I was super-charged with frustration. Sometime in there it came to me: I could simply say NO to the colonoscopy! Not forever, but for now. I can’t afford the weight loss and I’m not having GI issues.
Saying no: Alternate online guidance says Yes to creamy peanut butter!
At home, I emailed both the endocrinologist who is managing my osteopenia and blood glucose care, and my GP to keep him in the loop. The endocrinologist applauded my decision! The GP said no problem, he’d set me up with a Cologuard ® test (most simply described as “poop in a box”)- –
What did you just say?
Never mind, 9. Anyway, that test, if the result is what I anticipate, should be good for 3 years. Plenty of time to gain weight so I have a bit to spare. Hey, Lily?
Quiet, please I’m trying to concentrate!
I left no ring with her. What means this lady?
Fortune forbid my outside have not charmed her!
She made good view of me, indeed so much
That methought her eyes had lost her tongue,
For she did speak in starts distractedly.
She loves me, sure! The cunning of her passion
Invites me in this churlish messenger.
None of my lord’s ring? Why, he sent her none!
I am the man. *
Okay, you learn your monologue and I’ll learn this lesson over and over and over again:
When your mind is fluttering with red flags, it’s time to say no.
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Twelfth Night by William Shakespeare, Act II scene ii
