Occasional Limericks Only #40

Still not quacking…

This is a longish one, so if you only want the limerick, just scroll to the end.

Regular readers may recall my recent sports-related injury of the is-it-or-isn’t-it-a-hernia variety (it looked like a duck and walked like a duck, but didn’t quack like a duck). The colorectal surgeon to whom I self-referred a few weeks ago wasn’t convinced that it was a hernia (no ‘bulge’ and the pain was a bit far away from where you’d expect it to be in a bloke). Consequently, she referred me for a CT scan both to check for a hernia and to eliminate any other pathology.

The CT scan results were mildly alarming. There was some apparent irregular thickening of the caecum that extended into the ileum (the ileum is the final third of the small intestine and the caecum is where the large and small intestines meet). Irregular thickening of the bowel is not a good sign apparently, so I was referred for an urgent colonoscopy to rule out anything sinister.

Fortunately, there were also some encouraging signs that indicated either a less serious cause of my pain or that any neoplasm, if present, was at an early stage. This was because the CT scan had shown that my abdominal lymph nodes were all less than 1cm long (Dr Google says that, generally, you’d be concerned if they were greater than 1.2cm in length, but less so if they were shorter than 1cm). Also, I’d not lost weight suddenly or unexpectedly, and there were no observable bloodied stools exiting stage right.

So, a colonoscopy was arranged for the week after Hogmanay. That’s not something that would normally be high on anyone’s New Year wishlist, but I have to say it was a fairly benign procedure. The good news was that my innards showed nothing of concern. Although the biopsies have yet to be examined, the consultant was pretty well convinced there was no thickening as suggested by the CT scan, but, simply, a harmless quirk of anatomy.

Once the doctor was happy that everything looked fine, I then got a guided tour of my caecum and terminal ileum courtesy of a handily placed TV screen. One of the ‘quirks’ was that the valve between the ileum and the caecum, the ileocecal valve, was ‘prominent’ (I thought it looked like a sea-squirt!). The other quirk was that the so-called mucosal folds of the large intestine were also prominent (the inner view of the large intestine reminded me of the accordian-like folds of a tumble-drier ventilation hose). As a bonus, I also got to see my appendix from the inside.

Given there was nothing found of obvious concern, I can say with hindsight that the whole process was fascinating. The consultant managed to navigate the endoscope deep into the distal end of my ileum, rounding three right-angled bends, to a total ‘depth’ of 1.6 metres. How they manage that is beyond me!

The road less travelled… (1) Terminal ileum; (2) Caecum extending to the proximal ascending colon; (3) Rectum. The little spidery thing represents the location of the ileocecal valve and the dangling appendage is the appendix.

To ensure that a complete job was done, a number of biopsies were taken at the caecum and the ileum. An open-jawed instrument was placed against the tissue, snapped shut and, literally, ripped away from the intestinal wall. (The clarity of the image that I could see was due to a ‘well-prepared bowel’, ie, two days of fasting, gallons of water drunk and two doses of Picolax on the second day coupled to a frequently visited, adjacent loo.)

I watched the biopsies in real-time, but felt nothing. That was quite weird, as I thought it might nip a bit as I was only on pain relief when they were navigating the camera to the furthest point examined. Once there, there was no apparent need for it. I’d chosen self-administered Entonox (gas and air) rather than a vein-delivered sedative; largely because my other half had rather enjoyed tripping on gas and air during childbirth!

(Some people forego any form of pain relief as, generally, you are told you may experience only mild discomfort, but as I’m a coward with a low pain threshold I chose to get high.)

Consequently, I was only loosely aware of subsequently taking part in what must have been a surreal conversation with the chatty nurse at my head end. Pre-procedure literature had warned that the gas they use to inflate the intestines for observational purposes may make me feel uncomfortable and a bit windy afterwards, so, when asked how I was going to spend the rest of the day, I think I replied: “Farting!”. I can also remember referencing the ‘blood donor’ episode of Hancock’s Half-hour for some reason, but only after ensuring that all present were aware of who he’d been and emphasising that he was only known to me through repeats of his TV show as “even I’m not that old”.

Chatty nurse also asked me what I did for a living. I replied that I was now retired from Aberdeen’s Marine Laboratory, so she let me know that she was friends with a ‘bit of a character’ who worked there. I, of course, then regaled her with some colourful anecdotes about said ‘character’. As I was tripping quite high by then, I sincerely hope that I didn’t mis-remember them or  conflate them with tales of other characterful Marine Lab staff (of which there are many).

Having successfully traduced my former colleague whilst lying on my left side, I was asked to change position onto my right side. Chatty nurse missed that manoeuvre as she had left her post for a couple of minutes and, when she returned, exclaimed “Oh, I didn’t see you change sides!”. I’m embarrassed to say that was when I compared myself to a deity: “Oh yes”, I said, “I’m like God – I move in mysterious ways!”.

The final topic of narcotically-induced conversation was the tale of ‘just a little prick, sir’ from many years ago when I’d had the snip. I think that, on this occasion, it must have been the nadir of my story-telling because as soon as I’d finished it they placed the Entonox out of my reach.

So, where to now? In terms of diagnosis, other than counting out a bowel problem, I’m back to square one. When I next see my consultant I’ll perhaps suggest a second look at the CT scan in case an apparent irregularly thickened bowel diverted the radiologist’s focus from a more benign issue that may have been present. If not that, then what?

Here’s the limerick.

A patient lay prone on his side
Thinking “Hmm, this is not dignified!”
As a doc tried to pass
A ‘scope up his ass
To a metre and a half deep inside

Postscript: a couple of days after undergoing the colonoscopy, I read a news article that referenced Whitney Houston’s song, Greatest Love of All. I couldn’t help but think it would have ended me completely if, when lying prone with an endoscope a metre and a half up mon derrière in full view of four onlookers, I’d heard her blasting out the lines:

No matter what they take from me, they can’t take away my dignity!

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😎 Former scientist, now graduated to a life of leisure; Family man (which may surprise the family - it certainly surprises him); Likes cycling and old-fashioned B&W film photography; Dislikes greasy-pole-climbing 'yes men'; Thinks Afterlife (previously known as Thea Gilmore) should be much better known than she is; Values decency over achievement.

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