FIT kit image

FIT for a couple scopes

With long-term IBS and a near year-long H Pylori infection triggering a specialist consultation, I’m not sure I really needed to add anything to the 2020 GI bingo card. In the meantime, however, it occurred to me that I hadn’t done my biennial FIT (Fecal Immunochemical Test) in far more than two years. I suspect three moves in a couple years probably rendered my reminder lost in the mail. I could only recall doing one at 50 and 52, and turning 56 this year meant I was nearly two behind. So, sometime in June I had my doctor request a FIT kit and submitted my sample. Even with my history of hemorrhoids, my previous ones had always come back negative.

For those unfamiliar with the FIT, it’s a small stool sample test that detects blood. In BC, if you’re 50 or over you should be getting one every two years, as it’s become the BC Cancer standard pre-screen for colorectal cancer. Interestingly, I’ve read that if you have an immediate family member who’s had colorectal cancer, you should begin tests when you’re five years younger than their age of diagnosis.

With the Pantoprazole not really controlling my acid and heartburn and a raging H Pylori infection, by the late spring and into the summer my IBS was flaring up a lot and I was having heavier and more persistent hemorrhoid action than usual. As such, when the FIT results came back abnormal, I wasn’t completely surprised.

The standard procedure when you have a positive FIT is for BC Cancer to follow-up and do a colonoscopy. When I called their info-line to ask about timing, they were calling about five or six weeks after test results. When I talked to my doctor, however, he said that since we already had a request in for a specialist referral due to the H Pylori (and likely endoscopy) he would use the FIT result and contact him again to see if we could get things moving a little faster. The initial request had probably been made two to three weeks before the FIT, and it would be August before they called me with an appointment.

On September 22nd, I had my phone consult with the Gastroenterologist, and after going over all my symptoms and options for getting both scopes done, I opted for the two-fer and had an appointment for an upper endoscopy and colonoscopy at the same time, on October 15th. I figured since you need sedation for each procedure, it was better to do them together.

I really can’t say enough good things about my Gastroenterologist, Dr. Greg Rosenfeld. He’s pretty highly regarded and well-reviewed. He’s in private practise and also works out of St. Paul’s GI clinic. On the phone, he was thorough and knowledgable and he was excellent doing the scopes.

The logical side of my brain said, “it’s probably just hemorrhoid blood and nothing to worry about,” but the side of my brain that overthinks literally everything (ask anyone in my family) started putting it all together and worrying. I had a frothy mix of excessive heartburn, gut aches, bloat and gas, unpleasant bathroom adventures and blood that I couldn’t be sure was caused by hemorrhoids. And now, two scheduled scopes to see if anything serious was going on.

Scopes

Prep

By the time October 15th arrived, I’d had H Pylori symptoms for close to a year, had two rounds of multiple antibiotic therapy, been on Pantoprazole for most of nine months, and had several increasingly unpleasant symptoms over the summer and fall. The scopes wouldn’t fix any of this, of course, but would either set my mind at ease or tell me what was going on.

Colonoscopy prep begins a week before the event, with pretty extreme diet modification, particularly if you just eat plants. All beans, legumes, whole grains and seeds, berries, raw vegetables and “high residue” foods had to be eliminated. I was left with things like soda crackers, white breads, nut milks, peanut butter, cream of wheat, clear juices and broths.

Along with being hungry and bored while eating this way, something good actually happened. My gut felt a lot better, normal in fact. No heartburn, gut aches or bloat at all. While I was still dealing with some IBS symptoms, my hemorrhoid symptoms also eased somewhat. Then, the day before the scopes, I was on a purely jello and clear fluid diet with a four litre chaser of electrolyte-infused laxative, consumed in halves at noon and 8pm. I’ll spare you most of the details, but you REALLY clean out. By the end of the day it’s just clear fluid from the front and the back.

Endoscopy and colonoscopy day

I was given the choice of an early morning or mid-afternoon appointment. Since you can’t even consume water the day of the scopes, I really wasn’t interested in waiting until the afternoon, so I booked the 7:30am appointment at St. Paul’s. It took about 10 minutes to get checked in and then probably 45 minutes for getting changed and hanging around on a gurney until they wheeled me into the room for the sedation and blood pressure monitor hookup.

I’d love to tell you all about the procedure itself, but most of it is a fog. Around 8:30 they got me into a chair, monitored my blood pressure (mine always spikes when I’m in hospitals, but was downright mellow after I was done), and started me on a sedative drip. I’m not sure what they use now, but having had Demerol many years ago before a procedure, and something intense when they put my dislocated shoulder back into place in 2016, it wasn’t as strong as either of those.

photo of a bite guard
Endoscopy bite guard

Once I was wheeled into the procedure room and Dr. Rosenthal came in, they put a bite guard in my mouth to facilitate the endoscopy. As the sedative began to take effect I distinctly recall exchanging a few bowel jokes with him as he began to snake the scope down my throat for the endoscopy. At some point, I also vaguely recall the transition between procedures to my back side and the only thing I remember after that was being cleaned up after it was over. Given that the procedures take over an hour together, the sedative really does its thing because I don’t remember any discomfort at all.

My most distinct memory from this time was Dr. Rosenthal telling me everything was clear. I had no indications of esophageal damage or ulcers, no stomach ulcers, no colon problems of any kind, including polyps — nothing. Well, nothing aside from a sizeable hemorrhoid. He also took a stomach sample for biopsy to determine with absolute certainty whether I still had H Pylori or not.

I was wheeled into the recovery area for about half an hour and by 10:30 I was on my way home. The sedative effects are pretty clean and really don’t last a long time. I’d say by mid-to-late afternoon I felt pretty normal. I eased back into eating and within a day was back on my normal diet. Finally, when I had my follow-up with Dr. Rosenthal two weeks after the procedure he confirmed that I definitely no longer had H Pylori.

In the end

There are really no nuggets of advice I can share about a FIT, other than to be getting them done. After lung cancer, colorectal cancer is the deadliest cancer in the world, causing over 860,000 deaths (WHO, 2018) worldwide. It also has one of the highest cure rates when caught early. In other words, talk your doctor and begin getting pre-screened at the right time.

With regard to endoscopies or colonoscopies, again there’s really nothing much you can do other than to follow the prep instructions to the letter. I did and, coupled with a good Gastroenterologist, the entire day went without a hitch.

Hemorrhoid considerations

While hemorrhoids aren’t directly related to colonoscopies, their symptoms can mimic more serious conditions and cause a positive FIT, as they did with mine. So, a couple thoughts.

I’ve found OTC remedies like Preparation H to not be very effective, but recently new products have appeared at drug stores in Canada under the brand names Hemovel and Venixxa. Their active ingredient is called Diosmin, a flavinoid extract of citrus fruit, which has been used to treat veinous blood flow issues for years in Asia and Europe. You take 36 caplets over several days.

My evidence is purely anecdotal, but the swelling and bleeding have been gone since I took it in late September. When I asked Dr. Rosenfeld about Diosmin, he said it would be safe to use for multiple flare-ups in a year if necessary. Unless things go sideways, I like this as a non-invasive solution as opposed to bandings.

Regarding the banding procedure, I had one a few years ago and got pretty good relief for quite a while. There’s a little discomfort, but it’s a fairly simple procedure. If you have a fair bit of action down there, talk to your doctor about the procedure.

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