Friday, March 18, 2011

Virtual Colonoscopy

Wanna' see a squeaky-clean colon? I'll treat you to a look at mine -- at least a digitally re-created version of it, anyway.

In 2005 I decided to have a colonoscopy and investigated "virtual colonoscopy" (v.c.), a technology I had read about. At that time, there was one company that was the leader in the field. and there were hospitals/clinics across the country that had installed their technology for doing v.c.'s. There was one in Greensboro, NC, so I made an appointment and had the procedure done.

Here's the difference between a traditional, invasive colonoscopy and a non-invasive v.c. (both procedures require thorough emptying and cleansing of the colon before the procedure):

Traditional: insert a "snake" with a camera attached into the rectum and thread it through the colon while the doc watches the images returned by the camera on a screen -- looking primarily for pre-cancerous polyps or other abnormalities. If polyps are found, the snake can produce a wire lasso that clips the polyp off the colon wall. Sedation is required meaning a traditional colonoscopy is a tag-team event: you and someone to drive you home.

Virtual colonoscopy: inflate the colon with carbon dioxide gas via the rectum. Lying on a table, you pass through an imaging machine (either CAT or MRI) where 3-D "slices" of the colon are captured and saved to a computer. The computer software then creates a 3-D image of the interior of the entire colon which the doctor can then "fly" through and look at every nook and cranny of the colon wall. The carbon dioxide gas dissipates from the body and you're done. The downside of the v.c. is this: if polyps are discovered, you still have to have a traditional colonoscopy done with the snake, etc., so they can go in and clip the polyps off. Remember that the v.c. is non-invasive, so it can't clip polyps off since it's not actually inside the colon. Knowing that, I took a chance on my colon being in pretty good shape and not having any polyps which turned out to be true.

I didn't choose v.c. for fear of the invasive nature of the traditional method. I just like technology and cutting edge stuff so opted for the v.c. Everything I read about it, and was told pre-op by the clinicians, was that it was virtually "painless" -- just a slight expansion of the diaphragm area as the colon inflates.

That was the understatement of the decade. It turned out to be one of the most uncomfortable experiences of my life -- VERY painful -- and here's what I think happened: I think the technician pumped in WAY more gas to inflate the colon than was needed. I thought I was going to explode. I could hardly even turn myself over on the table to make the second pass through the imager. As much as I don't like to express pain, I was moaning and groaning like a medieval heretic on a rack in the basement of an inquisitor's castle. I spent 20 post-op minutes on the floor of a bathroom waiting to deflate, after which I felt fine.

Time for my next objective: Get the doc to show me my home movie. He was a young internist with sterling credentials and more than happy to show off his high-tech toys. The software had crunched the images together into a movie by the time I was dressed, so we sat down in front of his monitors and watched the fly-through. He commented on what great distention (expansion) I had (that was my first clue that the technician had over-inflated my colon), and said it all looked great -- no polyps or any other problems.

Because the movies were in standard .avi format I asked him if he would burn them to a disc for me that I could keep: "No problem."

There were two different movies on the disc -- the one below is the shorter of the two showing the lower end of the colon (cecum) near where it connects with the small intestine. The other longer movie wouldn't play when I got it home. Apparently there was a glitch when he burned it to the disc. Lucky for you -- you only have to see part of my colon.

Pretty cool, huh? (Remember: these are digitally drawn images, not pictures. There are movies on YouTube of colon interiors taken with the camera used in the traditional method. Needless to say, those movies are a bit, er, messier looking than these.)

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