Flex Sig was Big

The employee health service at the company where I worked offered many services during its heyday. I described my Employment Physical there in one of my other blog posts, and they continued to do routine, mandatory physicals on all employees for several years. They had a walk-in clinic for minor ailments, and employees could get counseling from medical professionals on how to deal with most any medical concern, including psychological needs. Sometimes they also made special arrangements with nearby clinics for certain services. For example, they had arrangements with local allergists so that employees could get their regular allergy desensitization injections without leaving the workplace. They made arrangements with a local radiology clinic for female employees to have routine mammograms. These services were optional, unlike the mandated physicals.

By the early 1990s, flexible sigmoidoscopy for colon cancer screening and for other diseases of the colon and rectum had become big. Lots of primary care physicians were pushing it. Our employee health service made arrangements with a local gastroenterology practice for employees to have routine flexible sigmoidoscopy provided at no expense to the employee. It was available to any employee over age 50 or who had a family history of colon cancer or other reasons for evaluation of the colon.

I was not yet over 50 years old but I had a family history of colon cancer and had some mild IBS-D. So I signed up. Lots of my colleagues did, including at least one friend and colleague who was the same age as I was. If I recall correctly, I was about 35 years old then. When I called the clinic to schedule the exam (which was scheduled through our company’s health service), they told me I would have to do a colon prep the morning of the exam and that I should stop by the health service to pick up the prep materials and the instructions for the prep. They told me I could fill out the questionnaire for the gastroenterology office right there and they would forward it to the gastroenterology office for me. It was all very convenient.

The night before the examination, I had a clear liquid dinner of broth, if I remember correctly. The prep was a “soda phosphate”, which consisted of dissolving the soda phosphate in 8 ounces of water and drinking it completely followed by more water. I was instructed to repeat this first thing the following morning. Yes, it was a complete purgative.

I arrived at the gastroenterology clinic for my procedure. The gastroenterologist himself came out to the waiting room to bring me back. He was a delightful middle aged hispanic man who clearly was striving to make me feel at ease. He took me back to the procedure room and briefly interviewed me, although he did so in an unhurried manner. I remember there was a proctoscopy table in the middle of the room, and a desk with two chairs off to the side where he interviewed me. There were also at least 10 flexible sigmoidoscopy scopes hanging from a rack along the wall. The doc then introduced me to his nurse, another delightful middle aged person. I don’t remember the names of either person. The nurse told me she’d be assisting the doc. She escorted me to the restroom which opened into the procedure room. She told me to empty my bladder, strip from the waist down, wrap myself with the paper drape, and come back into the procedure room.

I followed the nurse’s instructions. On re-entering the examination room, she had me sit on the edge of the proctology table, lie back, and then roll onto my left side. The nurse then lifted the drape to expose my buttocks. There were a few video monitors in the examination room, including one which I could see as I lay on the table. The doc asked me if I wanted to watch the procedure on the monitor. I suppose he could have turned off that particular monitor. I responded that, yes, I wanted to watch. Both the doc and the nurse stood at the end of the table near my buttocks.

As the doc was performing the requisite visual examination and digital rectal examination, the nurse was preparing the sigmoidoscope, including turning on the video. With the nurse’s assistance, the doc began inserting the scope in my anus, and I could see it approach my anus on the video monitor. He then deftly worked the scope up through my rectum, past the sigmoid colon, and into the descending colon. The sight on the video monitor was really striking to me, seeing my “innards” in this way. I was very much struck by how pristine the lining of the colon appeared. I suppose they filled my colon with gas to facilitate visualization but I have no specific memory of that. The doc withdrew the scope and handed it to the nurse, and he wiped me.

The examination itself was probably 5 to 10 minutes. The doc said that everything was “clean as a whistle”. He also said I did an excellent job with the prep, turning to the nurse and asking her if she agreed. She said my prep was as good as it gets. The procedure was really simple and with hardly any discomfort.

The nurse helped me off the table and said I could get dressed. As I left the restroom to leave the office, they handed me a one page report of the procedure, which I’ve long since lost.

I always wondered how they handled lubrication for these endoscopic procedures. I had flexible sigmoidoscopy one other time, and I’ll tell that story in a different blog. Flexible sigmoidoscopy long since fell out of favor, as colonoscopy replaced it. One doctor told me some years later that having flexible sigmoidoscopy for screening purposes would be about like a woman having a mammogram of only one breast.

I’d be curious to know if any of you had experiences with flexible sigmoidoscopy that you’d be willing to share.

(Photo from Flickr, free of copyright restrictions)