Serious colonoscopy questions

Background: In an earlier post I reported that my blood tests show that I had/have anemia (also spelt anaemia).  My doctor's initial reaction is to advise iron tablets, which I have to a large measure been taking.  He then also requested my local hospital book me in for an endoscopy, which involves sedation followed by a tube being passed down through the mouth into the stomach.  The goal being to do a physical examination of my insides.  This revealed, at worse, a hiatus hernia, which means that my stomach is pressing upwards into my oesophagus.

The hospital report on this was reassuring, that possibly 75% of older adults had hiatus hernia and that mine was nothing special.  I thus thought, well that was worth doing to find out not much wrong, and no particular harm done.

Actually after talking to a friend who has celiac disease it turns out that the way to solve a hiatus hernia, or at least make it no worse is to alter your diet.   The good news for me is the recommended diet is almost exactly my whole-food plant based diet.  But I need to do more research on this.

The purpose of this post is not to talk particularly about my anemia or my hiatus hernia, but I wanted to get the background right.  This is because my doctor has now recommended a colonoscopy.

My initial reaction, as before, is better to have an investigation and show there are no other problems.  Now I am not so sure and I have some questions:

Question 1:  Should I avoid taking Norgine's MoviPrep (pdf), the preparation drug that is supposed to clean my bowels?

You see if you look at the MoviPrep leaflet it states some reasons why you should not take the drug. Here is the full exclusion list.

Do not take take Moviprep Orange if you 

1. are allergic (hypersensitive) to the active substances or any of the other ingredients of this medicine
2. have an obstruction in your intestine (gut)
3. have a perforated gut wall
4. have a disorder of stomach emptying
5. have paralysis of the gut (often occurs after an operation to the abdomen)
6. suffer from phenylketonuria. This is a hereditary inability of the body to use a particular amino acid. Moviprep Orange contains a source of phenylalanine
7. are unable to produce enough glucose-6-phosphate dehydrogenase
8. have toxic megacolon (a severe complication of acute colitis).

Now let me take point 3, a perforated gut wall.  If I google that term it translates as leaky gut syndrome.  Well surely what I have is Rheumatoid Artthritis, and as far as my researches go so far that means I have leaky gut syndrome.  My whole dietary changes have been undertaken with the clear goal of repairing my leaky gut.

So do I still have a leaky gut?  I do not know.  I am not fully cured of RA, that is for sure.  I have changed my diet so that my gut health has improved over the last months.  But where does it stand on being perforated?  That is a question for my doctor and the hospital, at least.

Question 2: Going back to the instructions in the leaflet again, it advises in the last days before the colonoscopy to change my diet.  The advice is to eat white fish, chicken, white bread, eggs, cheese and potato.  These are some of the main foods I specifically avoid to help heal my body from Rheumatoid Arthritis.  What is this advice that specifically will aggravate my arthritis like crazy?  The advice continues to avoid all the foods that I normally eat.  Essentially they want a low-carb diet.  What do I do?

Again this is a serious question for my doctor and the hospital, and like the first question, if I do not get a satisfactory answer then I think I should postpone the colonoscopy.

Question 3: Are there links between the sedation and dimentia?

There is not doubt that many if not most people who have either an endoscopy or a colonoscopy have sedation.  One of the clear side-effects is at least a short term loss of memory.  This is clearly highlighted in the colonoscopy leaflet, as it was with the endoscopy leaflet.

However when I research the subject further I find there are people who think there are links between this kind of sedation and an increased risk of dementia in later years.

Question 4: My last question.  The length of pipe that is used in the colonoscopy operation could be inserted up my rectum is up to six feet in length.  Is it possible that the colonoscopy could itself damage my gut.

After all I have been taking extreme measures to heal my gut in every way humanly possible.  The idea that I might come out of the operation with a gut that is worse than I had when I went in is not what I want to hear.

To emphasise this the colonoscopy leaflet highlights the risks.  1 in 1000 patients end up with a tear in the bowel.  To my mind, 1 in 1000 seems quite a high risk.  And if we go back to my first question, that I have a leaky gut then does that mean I am, by definition, a high-risk patient?

That's the end of my questions so far.   I would love to hear from anyone who has questioned or even regretted having a colonoscopy.  Thank you for reading.

Update - more questions after more research.  I follow a number of doctors who publish exceedingly useful and reliable information around the subject of arthritis.  Reading their views on colonoscopy raise even more critical questions.

Question 5: Dr McDougall in his newsletter 2010 newsletter on colonoscopy (pdf)  talks about the balance of risks of death from a colonoscopy vs finding a cancer.  Interestingly these risks are very close, so he concludes for every person in whom a cancer is found another person dies from a colonoscopy.  This is an astounding revelation.  He goes on to argue that if you have a healthy diet then the risks of cancer of the colon are reduced by possibly a factor of 50.  Which is why he argued to avoid a colonoscopy for himself.

Question 6: Dr Greger of Nutrition Facts in his video https://youtu.be/4GDdWTnzVsU asks has proper informed consent been given by the patient.  He even quotes research that shows doctors clearly take the decision away from the patient in 98% of cases (in the USA).

I ask myself have I been informed by my doctor?  Nope just very strong advice, implying I would be mad not to have one!

Question 7:  Dr Mercola introduces a Dr David Lewis (video) who asks a serious question about the sterilisation of the endoscope / colonoscope.  The takeaway point is that the debris from one patient is likely to end up inside the next person because of the impossibility of proper sterilisation due to the design of the scope.  If the scope is cleaned using glutaraldehyde then the advice is to cancel the colonoscopy.  Ask what the sterilisation process is and glutaraldehyde is used as a cleaning agent.  You may need to check on the internet for brand names such as Cidex.

If the sterilisation is done using peracetic acid, that is a very good sign and you can have confidence the device is cleaned properly.