Blood in Your Stool?

I had some blood in my stool, and the discharge papers from a recent hospitalization for Sepsis said repeated bleeding should be treated by a return visit to the Emergency Room. So, off to the ER we went. The ER staff did some bloodwork, did a quick rectal exam, found blood, and I was admitted. This was on a Saturday, and on Sunday, the consulting Gastroenterologist stopped by and advised a complete Gastrointestinal series, including an Endoscopy and a Colonoscopy, as I had both red and dark blood in my stool. It had been four or five years since I had had a colonoscopy, and they had recommended no more examinations, as I had completed multiple examinations over the years without any reported issues. As it turned out, my dancing and celebration were somewhat premature.

The dreaded colonoscopy preparation

For those who haven’t had the pleasure of a Colonoscopy or endoscopic examination, your stomach and bowels have to be cleared of all matter. The Gastroenterologist will insert a fiber optic camera into your rectum, up through your colon, and as far as the intersection of your large and small intestines. They take pictures along the way, looking for polyps and other signs of illness, and another camera is down your throat, through your esophagus, and into your stomach to the junction of the stomach and duodenum, looking for ulcers and other signs of inflammation or disease.

Your bowels are cleared by having you drink a liquid preparation that causes you to defecate until you’re passing a clear liquid or liquids. No “color “ at all. Don’t think of an ice tea glass as the preparation is presented in a gallon plastic jug. It’s not that the prep necessarily tastes bad. It just doesn’t taste good at all. It’s made up of various salts that cause you to empty your stomach, small intestine, and large intestine, allowing your gastroenterologist the clearest possible view of the GI tract.

Enter Parkinson’s

One symptom of Parkinson’s is having a slow gut. A slow gut is a widespread, non-motor symptom of Parkinson's disease, caused by the degeneration of nerve cells and dopamine depletion in the digestive tract. This autonomic nervous system dysfunction leads to slowed peristalsis, resulting in severe constipation and gastroparesis. The techs from the GI Center who came up to interview me about the procedures seemed knowledgeable about Parkinson’s and slow gut, but still scheduled the procedures for the next day. Most people undergoing a colonoscopy only need to drink four to six liters of the prep solution over a six-hour period to clear their intestines.

In addition, they put me on a liquid diet consisting of jello, iced tea, a popsicle, a broth, a small sorbet, and cranberry juice. The last solid food I ingested was an order of scrambled eggs at 7 a.m. on Monday morning. The liquid diet was served at each meal time like clockwork. The liquid diet was brought up for review at the nurses' station to make sure I hadn’t ordered any contraband food items in addition to it. The nurses and technicians were very busy, and sometimes my liquid diet sat there until the popsicle and sorbet were melting and the beef broth was lukewarm. I started drinking the prep. To make it slightly more palatable, we filled a one-liter container with ice and flavored the prep with lemonade. I may never eat or drink anything lemon-flavored again.

I drank the first four liters of prep over several hours and waited. And waited. Nothing, not even a stomach rumble. It’s now late Monday evening, and the GI techs showed up to reschedule the tests, and the nurse came in bearing another four-liter bottle of prep. Everyone encouraged me to keep drinking. I’m not mobile due to severe peripheral neuropathy and advancing Parkinson’s, and I’m lying in a hospital bed with a separate commode standing by the head of the bed. Just getting transferred is a production. I thought this would never work if I had to go suddenly.

Premonitions can be correct

I drank the second four liters. And waited. And waited. Nothing. Enter the third four-liter bottle. It’s now around midnight to two AM when I feel a sudden urge. They managed to transfer me to the portable commode, and I managed to go some and just sit. They finally transferred me back to the bed. I continue drinking the third bottle of prep. Hours pass, and finally disaster happens. They didn’t get me transferred, and I had explosive diarrhea in bed and on the floor. This scene repeats over and over. I think of a 1993 movie, “Groundhog Day,” where the same scene repeats over and over.

The nurses and techs are incredibly cheerful, and soon we’re telling one-line jokes like “Clean Up in Aisle Four” or “Did your friends ever tell you you were full of 'it'? At the same time, I’m humiliated, embarrassed, and angry at my Parkinson’s slow gut. It’s Wednesday evening, and the GI techs say, “Better, but you’re still not clear,” and hand me the fourth four-liter bottle. I’m in tears, looking like the Pillsbury Dough Boy and saying I can’t do this, but I soldier on. I am finishing the fourth bottle on Thursday morning when the GI techs show up with a gurney and say, "We’re doing this no matter what." Down to the basement and a few words with the surgeon and anesthesiologist who will be performing the procedures. Rolled into a really cold room and was told to roll over on my left side.

I wake up only a few minutes later. Propofol is a wonderful anesthesia. The surgeon says they found and cauterized a bleeding ulcer where the stomach joins the duodenum, and, in my case, probably caused by large doses of a strong antibiotic, and removed a large polyp from my large intestine, and sent it out for biopsy.

Thoughts about what I’ve written

• Parkinson’s slow gut is a real thing.
• People with Parkinson’s may have trouble with a colonoscopy prep.
• Blood in your stool should always be investigated.
• Gastrointestinal (GI) cancers originate in the digestive tract, including the colon, rectum, pancreas, stomach, liver, and esophagus.

My reward for this ordeal was the recommendation to have a repeat colonoscopy in two years.