Getting to the Bottom of the Matter
After having first developed hemorrhoids at age 15 (see Hemorrhoids R Us), I only had occasional flare-ups in the course of the next several years. But by the time I was in my mid 30s, the hemorrhoids were raising their ugly heads again. I started having the bright red bloody spots on the toilet paper from time to time, and none of this was helped by my irritable bowel syndrome. Hygiene after bowel movements had become challenging. I decided to take the bull by the horns and get proper medical treatment, which I should have done years before when I first developed the problem.
I did my homework. I found a colon & rectal surgeon who specializes in the diagnosis and treatment of diseases of the anus and rectum. I’ll refer to him as Dr. G. I called his office for an appointment. The receptionist instructed me to take two of the store-bought Fleet enemas just before coming to the appointment.
I arrived at the office the morning of my appointment having done my enemas. The very friendly receptionist opened the sliding glass windows at the reception area to greet me and to give me forms to fill out. She told me that Dr. G was finishing up with the previous patient and that I’d be called back in about 20 minutes. She asked me if I wanted a refreshment while I waited. I selected juice. I was the only person in the waiting room. I sat down to complete the forms and the receptionist walked out into the waiting room to hand me my cup of juice. The forms were very simple, just asking the reason for the appointment, relevant medical history, relevant family history, and list of prescription meds (I wasn’t taking any back then).
A short while later, the previous patient walked out. The receptionist appeared at the door to the waiting room a few minutes later and told me to come on back. She brought me to the consultation area where Dr. G was sitting at his desk. He shook my hand and invited me to sit in the chair opposite him. I remember he was wearing a seersucker suit, which were certainly uncommon. He briefly reviewed my reasons for the appointment and my medical history. He then told me a little about himself and his practice. At that point, his nurse appeared at the door to the consultation room. I think he introduced her as Jean and that Jean would get me ready for the examination.
With a pleasant smile, Jean asked me to follow her to the procedure room. She explained that she would be with me for the duration of the examination and we’d start by taking my blood pressure. She had me sit on the chair in the procedure room which gave me a chance to size up the office, which was very distinctive. The office was quite modern with a large picture window in the procedure room with no curtains. It had a view of trees, the big boulevard in front of the medical office building, and the hospital across the street. The office was on the fifth floor of the building. I wondered about privacy but I had driven past that building many times and had the impression that it was not possible to see inside, the windows being like one-way glass.
Other features of the office were that it was very open. The door from the waiting room opened to a small central hallway, with the receptionist’s desk to the left, the restroom next, then the procedure room, the doctor’s consultation room, and finally a room with office equipment and filing cabinets. There was also an equipment room off of the procedure room which I surmised also contained the equipment for cleaning and disinfecting the medical instruments. Only the waiting room and the bathroom had doors, although there may have been a “pocket door” to the doctor’s consultation room but, if so, it was fully open. So the office was very open and bright and cheery. The window to the receptionist’s office was canted at an angle, so that patients standing at the window in the waiting room could not see back into the rest of the office. But the receptionist from her chair could see much of what was going on in the office. I had an impression that the receptionist was also a medical assistant. The procedure room was definitely well-equipped, but I didn’t really get a good look at the equipment.
There were three people working in the office, the doctor, Jean the nurse, and the receptionist whose name I forget. Their cheerful and friendly and casual demeanor was clearly intended to help patients feel at ease and confident despite having a very invasive and intimate procedure done.
Jean showed me to the restroom. She asked me if I had done my home enemas. She told me to empty my bladder and take off everything from the waist down. She asked me if I was wearing an undershirt. When I said yes, Jean suggested that I also take off the outer shirt so that we wouldn’t have to deal with the shirt tails during the procedure. She gave me a pair of those non-slip socks that hospitals often provide patients. She told me to put those socks on and wrap myself with the paper drape and meet her in the procedure room when I was finished in the restroom.
I walked into the procedure room wrapped in my drape with my tee shirt and socks. Dr. G was getting his surgical gown on over his seersucker suit and donning his gloves. Jean already had her gown on over her scrubs. She told me to go to the side of the procedure table closest to the window, sit down on the table and then lie on my left side. Jean told me to draw my knees up, and she then positioned my right leg slightly beyond my left. She ensured I was well-draped but with my buttocks exposed. In this very open office, it meant that all three people could see my backside. There was a pillow on the table so that my head and neck were straight and comfortable. They had done a good job of helping me feel at ease, considering the circumstances.
Dr. G then said he’d tell me everything as he went about the procedure. After elevating the table to a comfortable height for him to conduct the procedure, he first visualized my anus and pudendal region and buttocks. He then did the digital rectal exam, followed by insertion of an anoscope. He was manipulating the anoscope so as to fully examine my anal mucosa. He withdrew this instrument and then inserted a proctoscope to examine six inches or so of my rectum. I believe these were metal instruments but I’m not sure. He told me what he was doing at each step of the examination.
After withdrawing the proctoscope, he told me to roll onto my back. Jean kept me draped as I rolled, although lowered enough so that Dr. G could palpate my abdomen. As I continued to lay on the table, Dr. G explained to me that I’d benefit from having injection sclerotherapy. This he said consisted of injecting into the veins responsible for the hemorrhoids a substance that would cause scarring of the veins and thereby block the distension of the offending veins. He said it was a simple procedure that he could do right then. I said ok. He further said that I should have flexible sigmoidoscopy to examine above my rectum up through the sigmoid colon and into the lower part of the descending colon. He said I could have that as part of the same appointment since I had done a bowel prep (enemas). I said ok to that as well.
As my readers may recall, in the early days of flexible fiber optics, doctors were pushing flexible sigmoidoscopy to screen for colon cancer, diverticulitis and other diseases of the colon. Unlike colonoscopy, there’s no sedation. However, it was not popular for long, because colonoscopy soon replaced it, and so flexible sigmoidoscopy is rarely done nowadays.
Jean told me to roll back onto my left side, and she got me into position and draped just as before. As she was doing so, Dr. G turned on the small television that was on the wall in the procedure room. He tuned it to the Oprah Winfrey Show (of all things), which was pretty new at the time. I had never watched it before, normally being at work when her show was being aired. It seemed odd to be watching Oprah while having all these things done to my backside, but they were doing this to distract me from the procedure. He tuned the tv without gloves, giving me the impression that he then donned a fresh pair to continue.
Dr. G said he would start with the flexible sigmoidoscopy. I really don’t remember having much discomfort at all during this part of the procedure. I remember the receptionist came in and out of the procedure room a couple of times to ask both Dr. G and Jean various questions related to the business of the office, and this was another indication of how open and casual was this office.
Dr. G completed the flexible sigmoidoscopy and there was a brief wait while Jean took care of the soiled instruments and prepared the syringe for the injection sclerotherapy. Then the injections started. Jean spread my cheeks for the doctor and did so quite forcefully because they needed to expose as much anal tissue as possible, especially internal membranes. Yes, the injections were uncomfortable but not horrendous either. These took 2 or 3 minutes.
When finished, Dr. G said to remain on the table and then Jean would help me get up and escort me to the restroom where I could put my clothes back on. Then we’d talk in his consultation room again. It took Jean a minute or so to take care of more of the instruments. She then proceeded to wipe clean my anus and buttocks. She lowered the table and took me by one arm to help me up. As I pushed myself up from the table with my other hand, the drape fell to the floor. Neither of us made an effort to pick it up (I don’t think I could have since I was slightly light-headed at the time). Jean then walked me the 10 feet or so to the restroom in all my glory, genitals fully exposed, and even the receptionist saw me. But it seemed pretty inconsequential considering all I had endured that morning, modesty having fully evaporated for the moment. No one seemed fazed, and it was probably a common occurrence in that office.
In the few seconds it took to reach the restroom, my head cleared and I felt fine. Jean asked me if that was the case. She then closed the door to the restroom to give me privacy while I put my clothes back on and maybe pass a little gas from the flexible sigmoidoscopy.
I then talked for a few minutes to Dr. G. He told me my rectum, sigmoid colon and the part of my descending colon he could see were all normal and healthy and the only issue was the hemorrhoids. He said I should start getting benefit from the injection sclerotherapy in a matter of days and that I might have some swelling and spotting of blood in the meantime. I had no problems afterwards, and I did get a benefit from the injection sclerotherapy even though it wasn’t a cure.
I went back to Dr. G one other time which was two or three years later. It was a much different experience and not nearly so useful. My first appointment with him was a doozy.