Fasting again

On tap tomorrow is the endoscopic ultrasound. The prep and the procedure are much like a colonoscopy. The procedure will be in the afternoon, which means I have to fast all day Wednesday (liquids only), take four Dulcolax tablets mid-afternoon, and do half the prep (MiraLax) late in the afternoon and into the early evening. Thursday morning I will do the other half of the prep. My colonoscopy in September was early in the morning and fasting and doing the prep the day before wasn’t a problem. I expect this will be a bit more difficult from the standpoint of having to fast for more than a day and a half. Doing without even one meal is not something I like to do.

This ultrasound is being done to get a better look at the rectal cancer. By using an endoscope with a transducer on the end and placing it adjacent to the lesion and the wall of the colon, a more accurate picture can be obtained than is provided by a CT scan. It is also possible to view adjacent organs and, especially important in my case, nearby lymph nodes. The resulting images will be used with next week’s CT scan (the simulation) to design the radiation treatment.

In addition to the normal endoscopic ultrasound, I agreed to participate in a clinical trial that entails placing small, gold markers (fiducials) near the tumor during the procedure. The expectation is that the markers will help the radiologist better aim the radiation treatments. Traditionally, small marks are made on the body with permanent ink to serve as reference points. Those marks can move relative to the tumor, especially as the body changes over the course of treatments, so they aren’t exact. I will still get those external marks, but the fiducials will provide additional references. I thought that if it helps aim the treatment, it’s a benefit to me. Also, since it is being done as part of the ultrasound I was having anyway, it doesn’t add another procedure or any inconvenience on my part. It only adds about ten minutes to a procedure that was forty-five minutes to an hour long.

I started my pre-prep Monday night by eating a sweet potato for dinner – no meat. Throughout Tuesday I ate low fiber foods; again, no meat. My hope is that will make the prep easier. Being limited to clear liquids all day Wednesday with the prep not starting until late afternoon will be especially challenging. It is interesting that the list of “clear” liquids includes broth (which I do not like), coffee and tea without cream, and Coke and Pepsi products. Tea and Pepsi will be most popular with me. Gatorade is highly encouraged. I can tolerate it and will make myself drink some to get the electrolytes, but it isn’t especially appealing.

My next post will report on how the prep and procedure went. At least the likelihood of some sort of surprise during the procedure, like finding cancer during the colonoscopy, is very small.