My Colonoscopy Story( Part 9/10)
Navigating the Maze of Healthcare, Recovery, and Personal Growth
Hi gutsphere Community
Introduction: My Personal Journey with Colonoscopy
Today, I want to tell a very personal story about my colonoscopy experience. My name is Bimal Maharjan. I am the founder of GutSphere and a lifelong GI survivor. This is the first time I am disclosing my identity because it's about time that I share my real story and why I am so interested in GI care, Gut Health, and the Gut Microbiome. Perhaps, I can share more about myself in some other edition. Today, I will limit my scope to my colonoscopy experience, which aligns well with the patient stories edition as part of the colonoscopy edition.
The Catalyst for Change: Reflecting on the Healthcare System
So far in this series, we have gone deeper into the colonoscopy procedure. I want to preface this by saying that I am a proponent of preventative screening so that proactive action can be taken to live a healthy and happy life. While I say so, I am also wary of the potential misuse of procedure prescriptions because of the structural stupidity of the US healthcare system or, to use a stronger word, the Medical Industrial Complex.
Today, I share an excerpt from my book ‘Living Constipation Free’. Actually, my colonoscopy experience triggered me to write the book. If you feel a sense of anger in my writing, then it’s a reflection of the state of mind I was in when I wrote this book. I have passed through that phase. Although I am wary of the structural stupidity and the incentives that drive the US healthcare system, I have deep empathy for doctors. As I realize, like patients, there are victims of the magical hands of the military industrial complex.
Here is my experience with Colonoscopy: Excerpts from the Introduction of my book.
Unveiling My Experience: From Shock to Action
Oct, 2016
It had been six months since my wife and I had moved to the United States. One morning, I felt pain while pooping, so I checked the toilet paper afterward. There was a patch of blood. I was initially shocked, but my shock vanished as quickly as it had come. Like most people, I ignored the problem the first time I saw it. I assumed it would go away by itself. And since it did go away after a day or two, I didn't make a big deal out of it.
Encountering the Healthcare System: A Routine Checkup
Two months later, I went in for my annual physical checkup. During the checkup, the primary care doctor asked me about my medical history. "I don't have any medical problems right now. Oh yeah, two months ago, I saw blood on the toilet paper. It went away within a day or two. And six months ago, I had a fever for a night. Other than that, all is well," I casually replied to the doctor. Our interaction was very routine. He took my vitals: blood pressure, temperature, pulse, and weight. Everything was normal. He ordered a few blood tests to check B12, Vitamin D, Iron, etc. Results all came back normal.
The Diagnosis and Initial Missteps
“Constipation could have caused the blood episode,” he commented, and then he sprinkled a new term called the Standard American Diet (SAD) in the conversation. He explained that SAD, which includes foods like pasta and fast food, has less fiber to form the bulk in stool. Therefore, he suggested eating more fiber. If the problem persisted, he recommended seeing a GI specialist, a doctor trained to diagnose and treat gastrointestinal (GI) tract and liver problems. I didn't see the GI specialist because my situation wasn't painful. Then, two years later, I saw blood in my stool for the second time. Between the first time and the second time, I had started experiencing constipation without realizing it.
Deep Dive into GI Issues: Recognizing the Problem
I assumed taking long poops (more than 15 minutes), straining or having difficulty passing stools, and having incomplete bowel movements was normal. According to the Mayo Clinic, chronic constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer. After the second time, the blood in my stool became a recurring episode. It had become a chronic problem. My constipation caused hemorrhoids (swollen veins in the anus and lower rectum) and anal fissures (small tears in the thin, moist tissue (mucosa) that lines the anus).
Taking Control: Self-Education and Empowerment
I lived with constant dissatisfaction because of incomplete bowel movements. I wish I had initially taken the blood on the toilet paper a bit more seriously. Had I been aware of my body, habits, and possible root causes for constipation, I would have prevented the constipation from becoming a chronic problem. I became serious after that and decided to act. "You must know more about your disease than your doctor," my mother said all the time when I was growing up.
Encounters with Healthcare Professionals: Insights and Frustrations
She was right. As a patient, it’s important to know as much as possible about your illness because it's you who has to live with it. So I took my mother's advice. Casually, I began to research. I learned basic things about constipation, such as eating more fiber, eating less meat, drinking more water, and exercising. I was absorbing so much information, but I didn't have a mental model or framework that holistically solved the problem. It wasn't until late 2019 when I started forming the framework and really understanding my issues.
Pursuing Relief: Realizations and Decisions
After the second episode, I played hide-and-seek with constipation for almost a year. When it returned, I treated it, and it went away. I forgot about it and got back to my usual self. Within a week or two, my constipation returned with blood. On the fifth of July, 2019 blood oozed out of the wound in my anus. It was an anal fissure. I had eaten a lot of red meat at a Fourth of July barbecue. The delicious, bacon-wrapped jalapeno and cheese didn't jibe well with me.
Seeking Medical Help: The GI Specialist Visit
I assumed nothing would happen because I drank a lot of water and walked a lot that day. But blood in my stool the next day made it clear my assumption was wrong. That's when I realized that I needed to do more, and I also needed medical help. I consulted my primary care doctor. He prescribed me generic ointment and recommended a diet change and exercise. But he didn't tell me what to eat and how to exercise. Instead, he referred me to a GI specialist.
The Cost of Care: Navigating Expenses and Recommendations
I visited the GI specialist. After checking my anus, he quickly diagnosed it as a fissure. He was in a rush and didn't say anything I didn't already know from the Google search. He recommended not to sit for long periods and to drink a lot of water, exercise, and eat fiber. He didn’t say anything more, but then he prescribed an ointment that had to be specially made from an apothecary and that cost $64, which was five times more expensive than the $12 generic one. I paid around $270 for a 15-minute visit.
The Colonoscopy Proposal: A Surprising Suggestion
I returned for a follow-up visit six weeks later, which was just five minutes of conversation. By that time, my wound had healed, and my constipation had eased. Everything was okay. I had done many things beyond applying the ointment to treat the fissure. And when the doctor noticed I was carrying a water bottle with me, he asked, "How many of those bottles do you drink a day?" "3 or 4." "That's good," he nodded. "Listen, we will have to do a colonoscopy to make sure it isn't colon cancer."
I am sure your insurance will cover it. Do you know of anyone in your family who had colon cancer or GI issues?" he asked. "Cancer? No one," I responded. "Think about a colonoscopy, and you can call my office to schedule it." That was the last sentence he spoke. I left the office feeling bewildered. Cancer? Colonoscopy! Why? I must give my doctors credit for suggesting that I might have a genetic propensity for constipation.
Family History and the Stigma of Constipation
My family on my mother's side have constipation problems. My mother has it occasionally. My grandmother, aunt, and uncles all have it. When I had asked my mother earlier about our family medical history, she had replied that no one had it. But when I quizzed her later, she revealed the truth. For some reason, constipation is shameful and taboo to talk about.
The Unspoken Epidemic: Constipation's Hidden Impact
In one estimate, millions of clinic visits each year and more than 700,000 emergency department trips are from constipated-related problems. Yet, most people keep it under the carpet. If more people talked about it openly, we could exchange experiences to treat, prevent, and cure the disease. I am sharing my experience here so that other constipation patients can learn from what I went through.
Overcoming the Challenge: Self-Education and Action
Very few things that helped me came from doctors. There were many things the doctors didn't ask. They didn't ask me whether I was chewing correctly or not. They didn't ask me much about nutrition and diet; the number of bowel movements I had per day; the shape, quantity, or color of my stool; exercises and water intake; stress levels or the nature of my work. Fortunately, you don’t need a doctor to tell you everything you need to know. A patient like me can share more from experience.
I ignored the GI specialist’s recommendation to get the colonoscopy done. I felt it was completely unnecessary because, by that time, I had started treating and preventing constipation myself. And I didn’t have other problems that would warrant a colonoscopy, such as bloating, stomachaches, nausea, or weakness.
A Shift Towards Self-Care and Prevention
A year later, when I went in for an annual physical check-up with my primary care doctor, he ordered a few blood tests. The blood tests showed a low ferritin level (if your blood ferritin level is lower than normal, it indicates your body's iron stores are low and you have an iron deficiency8) and high iron level. Usually, they are correlated, but in my case, they were not. I also had a low vitamin D level. The rest of the results were excellent, and I hadn't had any severe bleeding for the past year.
A Year of Surprises: Blood Tests and Concerns
My primary care doctor advised me to do a stool test to ensure there wasn't any microscopic blood in the stool due to internal bleeding. Later, he warned that I should do a colonoscopy to screen for colon cancer. So I called up the GI specialist to schedule the colonoscopy. Both of my doctors made me believe that it was a preventative screening, which would be 100% covered by insurance. I thought, "It won't cost me any money. It will just be a nuisance for a day and will help me rule out colon cancer." I did what my doctors recommended me to do. It took several calls to the insurance company and GI specialist’s office to schedule the procedure. I was 100% wrong about the cost, and the procedure ended up costing me a lot out of pocket.
Deciding on a Colonoscopy: Between Prevention and Cost
I never thought about writing a book about my constipation problem until I went through my colonoscopy experience. During the week of the colonoscopy, I lost 10 pounds—from 145 pounds (65.7 kg) to 135 pounds (61.23 kg). The colonoscopy was not a complicated procedure. I didn't feel a thing during the process because of the anesthesia they gave me. It was the before and after steps that troubled me. I had to fast a day before to cleanse my colon. And then afterwards, I couldn't start eating a proper meal for the next three days. I didn't eat my regular diet for almost a week, and because of that, I was weak from the sudden weight loss. Fortunately, when the test results came back, everything was fine.
The Personal Cost of Healthcare
It's not usual for an otherwise healthy 35-year-old man to get a colonoscopy. This procedure is normally recommended for people aged 45 and older. I understand that my doctor wanted to rule out colon cancer or any other severe disease. But he wanted to intervene inside my body before trying out preventive methods. Instead of suggesting high-fiber, iron-rich foods, taking vitamin supplements, drinking more water, and exercising at least 3 hours per week for a month to see how my bowel movement responded to those changes, my doctors weren't interested in exploring any of that. While there may be a time for aggressive measures, should a colonoscopy be the first choice of action? In my case, it led to the unintended consequences of weight loss, weakness, and financial stress.
Critique of the Healthcare System's Motivations
Doctors aren’t always to blame. It has been suggested that the U.S. healthcare system incentivizes treatment and defaults to the most expensive care option because it increases revenue for the hospitals, insurance companies, and healthcare systems. Some call the U.S. healthcare system a “medical–industrial complex” (akin to a “military–industrial complex”). So doctors may have the best of intentions, but they are limited by a structure that incentivizes treatment rather than a cure for a disease. I experienced the dark side of the medical–industrial complex when bills started coming in. Instead of being 100% covered by my insurance, I owed 100% of the bill. Because of the way the U.S. healthcare system codes for billing, my procedure was coded as diagnostic instead of preventative, so my insurance didn't cover the bill. Even more than the colonoscopy, the medical bills stressed me out. The statements came from different places: labs, a private anesthesiologist, the hospital, the doctor's office. The total amount was about $3,700. Shouldn't the healthcare system be concerned about both the medical health and the financial health of a patient?
A Philosophical and Personal Dissonance with Healthcare
Twelfth-century philosopher Moses Maimonides said, "The physician should not treat the disease but the patient who is suffering from it." I felt that my goal to live constipation-free didn't align with the goals of the healthcare system, and I was treated like a customer instead of a patient. I didn't want to hand over my health to a system that treated me that way. I was not a customer; I was a patient. I believe that the healthcare system has to think about health consequences and the financial implications of procedures, not incentives that are different from the patient's needs. Even as I write this, I feel uncomfortable because I usually find the good in a system and have a positive outlook on the world. But my experience told me otherwise.
Empowerment Through Self-Education and Experimentation
My experience reinforced my mother’s advice. As a patient, I needed to know more about my disease than a doctor. Doctors know what constipation looks like, but for them, I’m one more patient. For me, it's my life. I know from pain what constipation did to my mind and my body. Every glass of water I drank, I questioned whether it was enough. Every piece of food I put in my mouth, I evaluated whether it had enough fiber. Every step I took, I questioned whether it was enough exercise. It was highly stressful, and medical help wasn't enough. The doctors didn't have time to get deep into my problems and solve them at the roots. They had time to give small and vague advice, do more tests, and treat with medicines. None of that would help me prevent and cure my problem. I learned to avoid and fix by studying and experimenting with my body, which was something that I had to do myself.
Holistic Health Discoveries and Lifestyle Changes
I’ve spent thousands of hours researching, reading, watching, experimenting, thinking, measuring, and monitoring changes to my body over the past four years. As a result, I learned many things that my doctors didn't tell me. For instance:
Drinking two glasses of warm water in a squatting position as soon as you wake up in the morning can trigger a bowel movement.
You should eat water, not just drink water. Meaning you should eat food that has high water content.
The best way to poop is in a squatting position.
Eating ghee (clarified butter) can lubricate the intestines.
Turmeric can reduce inflammation.
Digestion starts at the mouth, and you should chew food to an almost puree before swallowing it.
Eating fermented food will improve gut bacteria.
Intermittent fasting can help ease the pressure on and reboot the digestive system.
Breathing exercises can reduce internal inflammation and increase the immune system.
Chewing fennel seeds can aid in digestion.
Wiping your butt and washing it can help avoid infections.
Running or walking may work better than yoga as an aerobic exercise.
If I wanted to be free of constipation, I would need to take charge of my life. For a chronic disease like constipation, I found that home remedies, behavioral changes, and long-term responses were the most effective. I needed to change my habits, which was something only I could do.
It took me years to improve my digestive health through trial and error. It's been months since I’ve had any constipation, and I can't point to one thing that changed my life. The holistic lifestyle is what made the difference. I want to share everything I know with my fellow constipation patients—the knowledge, tools, and habits that worked for me to live constipation-free.
If you are reading this book, you either suffer from chronic constipation or know someone who does. You picture a joyful life that is without chronic constipation for yourself or others. You want to earn that joy, don't you? It's possible. For that, you need to own up to the disease and make life choices that will help you beat it. I hope my story of how I beat the disease will help you earn your joy back.
Holistic Health Discoveries and Lifestyle Changes
This book is a result of my quest to live constipation-free. I will share how and when my problem started, what caused it, and how I went about treating, preventing, and curing the disease. Most of the things I found are nothing new. I feel blessed to have been born in an era when knowledge is easily accessible in books, videos, blogs, and podcasts. One just has to look for it. I spent thousands of hours researching and studying. As a result, I became a scientist of my physiology. This book is my effort to distill the information that I learned and what worked for me into actionable wisdom.
Closing Thoughts: The Power of Personal Agency in Health
A pill can't solve this ill. Only you can solve it. By taking charge of your health, you will acquire knowledge, techniques, and tools to become healthy and fit. I hope it inspires you to dream of a constipation-free life and then fulfill that dream.
As we reach the conclusion of this edition, I hope my journey through the intricacies of colonoscopy and the broader healthcare landscape has provided you with not just a glimpse into my personal battle with GI health, but also illuminated the path towards a more informed, empowered approach to managing one’s health. The experience, while fraught with challenges, has been transformative, pushing me to not only confront but also navigate the complexities of a system that often prioritizes treatment over prevention.
My story is a testament to the power of self-advocacy, the importance of holistic health practices, and the undeniable value of preventative care. It underscores the need for a healthcare system that aligns more closely with the needs of the individuals it serves, rather than the financial incentives that currently drive it. Through sharing this personal narrative, my aim is not just to highlight the shortcomings of the healthcare system but to inspire others to take charge of their health, to question, to research, and to advocate for themselves in the face of medical adversity.
As we move forward, let us carry the lessons learned from these experiences into our lives and the lives of those around us. May we foster a community that values open dialogue about health, challenges the status quo, and supports one another in the pursuit of wellness. Let this edition of the newsletter be a starting point for deeper exploration, conversation, and action towards a healthier, more empowered society.
Thank you for joining me on this journey. Together, let's continue to explore, understand, and improve our health, armed with knowledge, empathy, and a relentless drive for a better healthcare experience for all.
Yours in health and wellness,
Bimal Maharjan
Founder, gutsphere
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