Hi everyone! Hope the New Years is treating you well. I spent my New Years this year reading (Introduction to Probability, specifically  by Blitzstein and Hwang), sleeping, talking to the family, plumbing, and reading about colonoscopies. Skip to the colonoscopy section if you’re just here for the learning.

Here’s the plumbing story:

The pipe that connected to the sink where we were staying was busted, this icky, brownish good bubbled up from the bottom of the sink. First, we tried plunging the sink directly, as I covered the air pockets with both hands, he exerted his entire force into smashing the plunger downwards – WOOSH, WOOSH, WOOSH- went the plunger.

After 40 minutes, we were no farther than we had started, the level of murky water no lower than when it began. I decided to help the vacation home owner out a bit, and we took off the entire plumbing system, pipes and all, letting loose a torrential avalanche of slightly- used water, drenching him and me in who-knows-what.

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After the pipe had been removed and the area cleaned as to not warp the wood

The seemingly impossible task became more daunting by the minute. I picked up the plastic piping, taking care not to muddy all my clothes in the puddle of stagnant water. I peered down the depths of the U in the pipe. If anything, the blockage would be there at the bottom, the accumulation of years and years of turkey dinners, fatty steaks, and filet mignon. The grimace splayed across my face did no justice to the sludge that came out of the pipe. However, as my eyes picked out the details of the bottom of the pipe, it became clearer that the U wasn’t blocked. Of course to call it empty would be a gross mischaracterization but as I picked out the remnants of the pipe, I could see the light reflecting off the plastic and out the other side. We had not found the culprit.

Back to the car he went and with him, our hope for a quick and easy fix. We had the audacity to try again though. He returned 15 minutes later, a giant roll-up auger, dubbed “The Snake” firmly held in his right hand. The contraption looked like a giant top, except where the top of the top would be, there was a housing that you could roll clockwise or counterclockwise to wind the snake in and out of it’s burrow.

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“The Snake” and my foot, and the mopped up floor

The snake stretched 25 feet at its longest, fully unwound, like something you would see in an Indiana Jones movie. We placed the auger next to the recently opened pipe, the homeowner’s hand feeding in the auger, while I rotated the auger clockwise, watching the metal snake slink out slowly. He carefully probed for resistance as I continued to turn, but as we reached the 25th foot, no resistance was found. We had certainly run the length of the entire auger as the snake did not travel any further out of its housing and the clanging in the walls was definitely the movement of the snake, but alas, even 25 feet was too short. Unfortunately, that was the end of our capabilities and we relinquished the herculean task to a professional the next day.

The Colonoscopy:

Of course, the recounting of my misadventures was not merely done to entertain. The process of a colonoscopy is very much the same as cleaning out pipes with a giant auger. Gastroenterologists look for: polyps, colon cancer, diverticulosis, inflammatory bowel disease, bleeding, and obstructions during the process. [1] There’s a cool video here of a polyp being removed with a mini metal lasso during a colonoscopy: [2]

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The polyp in question being removed. The lasso can be seen within the transparent plastic.

The important part of the colonoscope is the thin end which can be used to squirt water or suction to clear stool (poop) or other debris off the wall of the colon. The polyp in question above may be possible colorectal cancer, and a lasso extends to cut the polyp. At that point, the polyp is suctioned into the endoscope and can be looked at later. Larger polyps, described as > 1cm in diameter have a higher chance of being cancer cells and may not be able to be remove by endoscopy.[3] The video by Dr. Darell Gray below highlights an excellent teaching example of a large polyp.

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Lasso extended around polyp on colon wall

Thinking back to high school biology, remember that the colon is what is known large intestine. The colonoscopy procedure traverses the rectum, sigmoid colon, descending colon, transverse colon, and ascending colon. Most of the procedure consists of getting a 360 degree view of the colon on the way out. Watching the video can be very disorienting as shown in this video by Wexner Medical Center by Dr. Darell Gray: [4]

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Different anatomical parts of the colon [5]
At the end of the procedure at the anus, the camera then is operated to look back at itself in a process called retroflexion and at the same time, to look for hemorrhoids, or swollen veins in the anus and rectal wall or scarring  due to radiation. [6]

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Colonoscope in retroflexed view at rectum. Can see veins around anus [7]
For all the important landmarks that we saw here, we didn’t see one important byproduct of digestion: stool. This is because patients normally “prep” for a colonoscopy by taking a laxative (i.e. Dulcolax or Miralax) and lots of clear liquid that helps them poop. [8] Thus, the colonoscope isn’t obstructed on entrance and exit of the colon.

And thats it! I hope you all enjoyed the parades and football games today. It was a real clincher with USC today. Regardless of where you are, I hope you’ve had an awesome New Years, and I look forward to seeing you soon.

Your friend,

Joseph

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