(over)prepping colonoscopy
October 31, 2021 12:34 PM Subscribe
doc’s recommended “split prep” seems extreme,
Current gi doc says they want me to do a “split prep”, which seems to be fairly common now. This means i have to take a dose of “Suprep” earlier in day before exam, and then again at *9pm*! I don’t see how they intend for me to sleep at all,l since i’m sure i’ll be up all night in the restroom.Is this really necessary vs how i used to do it (drinking the peg solution all afternoon but usually not having to go to restroom anymore by bedtime? )
Seems pretty dumb to have a person who just basically fasted most of a day, excreted all nutrients , to then stay up all night, followed by anasthesia (assuming they’re on time.)
I know YANMD, but asking anyway because this seems nuts. One person told me the colon will start to generate waste soon after you stop the purging, even if you consume nothing, or just water. Really? That much?
thx for your g.i info mefiters :)
Also this is my 4th? scope and even last one in 2017 they did not make me do this.
thx g.i mefiters:)
Current gi doc says they want me to do a “split prep”, which seems to be fairly common now. This means i have to take a dose of “Suprep” earlier in day before exam, and then again at *9pm*! I don’t see how they intend for me to sleep at all,l since i’m sure i’ll be up all night in the restroom.Is this really necessary vs how i used to do it (drinking the peg solution all afternoon but usually not having to go to restroom anymore by bedtime? )
Seems pretty dumb to have a person who just basically fasted most of a day, excreted all nutrients , to then stay up all night, followed by anasthesia (assuming they’re on time.)
I know YANMD, but asking anyway because this seems nuts. One person told me the colon will start to generate waste soon after you stop the purging, even if you consume nothing, or just water. Really? That much?
thx for your g.i info mefiters :)
Also this is my 4th? scope and even last one in 2017 they did not make me do this.
thx g.i mefiters:)
Response by poster: Nope. Prep sheet has handwritten on it 3pm 1st dose, 9pm second dose, finishing consuming anything (presumably water) no later than 3am. I will call them tomorrow to confirm but am pretty sure this is the intent.
posted by bitterkitten at 12:54 PM on October 31, 2021
posted by bitterkitten at 12:54 PM on October 31, 2021
this is how i've prepped for my last couple. it could be an hour or so of distress for the nighttime round, but as long as you're not doing anything other than sips of water afterwards, everything will, uh, pass quickly and it will be over sooner than the first round. You will not be up for hours. just don't consume anything other than the bare minimum for fluids between the 2 rounds and you'll be alright.
I've also done some light fasting or a low-residue diet starting a day or 2 before the first round of prep so that the first round is also less gnarly. The general idea is that the less stuff you have in your guts, the easier the prep will be (which is still sorta horrid).
posted by rye bread at 12:56 PM on October 31, 2021 [4 favorites]
I've also done some light fasting or a low-residue diet starting a day or 2 before the first round of prep so that the first round is also less gnarly. The general idea is that the less stuff you have in your guts, the easier the prep will be (which is still sorta horrid).
posted by rye bread at 12:56 PM on October 31, 2021 [4 favorites]
I had mine in 2017 and this is how my dr had me prep. It wasn’t pleasant, but I wasn’t up all night.
posted by bookmammal at 1:01 PM on October 31, 2021
posted by bookmammal at 1:01 PM on October 31, 2021
also, i'm on a relatively high risk schedule, so i get them every 2 years (down from every year), so it's not like i'm a connoisseur, but yeah, this has been the least terrible way for a while. suprep is still bleah, but better than the peg
posted by rye bread at 1:03 PM on October 31, 2021
posted by rye bread at 1:03 PM on October 31, 2021
This doesn’t seem too bad to me, you know, as far as colonoscopy preps go. My last colonoscopy was an appointment on Thursday afternoon and I had to start my fasting on Tuesday morning with my first prep solution on Tuesday evening. Then continued fasting and prep all day Wednesday. It was horrible. Even if this keeps you up for a couple of hours past your usual bedtime I would absolutely take that over a 48+ hour prep.
posted by scantee at 1:15 PM on October 31, 2021 [1 favorite]
posted by scantee at 1:15 PM on October 31, 2021 [1 favorite]
I'm a doctor
Proper bowel preparation strongly influences the effectiveness of colonoscopy
In no nonsense terms this means screening works only as well as your poop chute is clean.
Compared to cleaning all at once the day befvore, cleaning the night before and the morning of is associated with a 30% higher detection rate of the very things that justiify getting screened in the 1st place.
posted by BadgerDoctor at 1:40 PM on October 31, 2021 [40 favorites]
Proper bowel preparation strongly influences the effectiveness of colonoscopy
In no nonsense terms this means screening works only as well as your poop chute is clean.
Compared to cleaning all at once the day befvore, cleaning the night before and the morning of is associated with a 30% higher detection rate of the very things that justiify getting screened in the 1st place.
posted by BadgerDoctor at 1:40 PM on October 31, 2021 [40 favorites]
Anecdotally. This is pretty much how I prepped for mine it took about 45 mins to kick in I pooped for maybe an hour then it kind of trailed off and I slept fine. If you have been following the diet strictly, you basically empty out everything then it settles down. Doing it at 9pm, pooping until about 11pm then a drink and off to bed to sleep to recover as it is a little exhausting worked out great for me.
posted by wwax at 1:41 PM on October 31, 2021 [3 favorites]
posted by wwax at 1:41 PM on October 31, 2021 [3 favorites]
Response by poster: Thanks for all your input!
I understand the concept here, and as mentioned above, I think this is scope #4 for me. I am somewhat reassured by the above, but I will elaborate further.
I've had IBS-D for years. Presently, I already mostly eat a lowish residue diet and take a few supplements that keep it in check. Low residue diet has been prescribed as part of the prep, and it is not much different from my typical diet.
When I have a typical IBS-D 'incident', which is most often triggered by too much (in)soluble fiber, but not always, it usually takes me about 4-6 hours to recover from cramps and for my guts to stop wanting to expel everything from my rear. I fully expect this exam prep to cause a similar incident to the last colonoscopy, seeing as how I generally avoid any med that speeds up bowel time like the plague (unless there's something magical about SuPrep vs. my last test that required peg solution all afternoon + mag citrate on top of that).
Additionally I've got continual sleep disturbances already, underweight, general weakness, hashimotos, autoimmune gastritis, psoriasis, fluctuating anemia.
Doc knows all this but perhaps since they were not my g.i. doc for the last test this has not been taken into account.
I'm just sayin', I expect to react more violently than the average person going through the unpleasantness. If I have no other rational choice to get it done this way, then that's what I have to do.
badgerdoctor: thanks also for your specialized input. I am curious though; while the quality of the prep is clearly important, does this mean all my earlier scopes - which were never mentioned as "poor" on pathology reports - were actually not as good, because the bar for 'good' was lower?
Tangentially: I am disappointed that after 20+ years of colonoscopies, this is the best science has to offer (yeah yeah there's capsule endoscopy, but even though that's mostly safer unless the pill gets stuck, I feel it's actually worse for the patient since you don't have the benefit of being knocked out at the end. The only consolation I have is that 'modern' medicine is really not that modern, considering the history of humans. If it were 1000 years in the future I think I'd be a lot more pissed off.
posted by bitterkitten at 5:12 PM on October 31, 2021 [2 favorites]
I understand the concept here, and as mentioned above, I think this is scope #4 for me. I am somewhat reassured by the above, but I will elaborate further.
I've had IBS-D for years. Presently, I already mostly eat a lowish residue diet and take a few supplements that keep it in check. Low residue diet has been prescribed as part of the prep, and it is not much different from my typical diet.
When I have a typical IBS-D 'incident', which is most often triggered by too much (in)soluble fiber, but not always, it usually takes me about 4-6 hours to recover from cramps and for my guts to stop wanting to expel everything from my rear. I fully expect this exam prep to cause a similar incident to the last colonoscopy, seeing as how I generally avoid any med that speeds up bowel time like the plague (unless there's something magical about SuPrep vs. my last test that required peg solution all afternoon + mag citrate on top of that).
Additionally I've got continual sleep disturbances already, underweight, general weakness, hashimotos, autoimmune gastritis, psoriasis, fluctuating anemia.
Doc knows all this but perhaps since they were not my g.i. doc for the last test this has not been taken into account.
I'm just sayin', I expect to react more violently than the average person going through the unpleasantness. If I have no other rational choice to get it done this way, then that's what I have to do.
badgerdoctor: thanks also for your specialized input. I am curious though; while the quality of the prep is clearly important, does this mean all my earlier scopes - which were never mentioned as "poor" on pathology reports - were actually not as good, because the bar for 'good' was lower?
Tangentially: I am disappointed that after 20+ years of colonoscopies, this is the best science has to offer (yeah yeah there's capsule endoscopy, but even though that's mostly safer unless the pill gets stuck, I feel it's actually worse for the patient since you don't have the benefit of being knocked out at the end. The only consolation I have is that 'modern' medicine is really not that modern, considering the history of humans. If it were 1000 years in the future I think I'd be a lot more pissed off.
posted by bitterkitten at 5:12 PM on October 31, 2021 [2 favorites]
does this mean all my earlier scopes - which were never mentioned as "poor" on pathology reports - were actually not as good, because the bar for 'good' was lower?
I think of this as analogous to phone cameras, or any other tech advance. What was good or great quality five years ago is budget quality now. Same thing comes up a lot in mammograms.
It's also possible that your own colon would be wiped clean with a regular GoLytely prep, but Suprep is the only orderable option since the data in the last couple years demonstrates that split prep is superior. Evidence-based medicine is better than the alternative but doesn't typically make space for special cases like your update. Expect this to get worse, not better, in coming years with the implementation of algorithms and "Decision Support Tools."
The 9pm thing really should be clarified though.
posted by basalganglia at 6:32 PM on October 31, 2021
I think of this as analogous to phone cameras, or any other tech advance. What was good or great quality five years ago is budget quality now. Same thing comes up a lot in mammograms.
It's also possible that your own colon would be wiped clean with a regular GoLytely prep, but Suprep is the only orderable option since the data in the last couple years demonstrates that split prep is superior. Evidence-based medicine is better than the alternative but doesn't typically make space for special cases like your update. Expect this to get worse, not better, in coming years with the implementation of algorithms and "Decision Support Tools."
The 9pm thing really should be clarified though.
posted by basalganglia at 6:32 PM on October 31, 2021
I can't answer your additional questions about past colonoscopies without knowing
1) the test's Likelihood Ratio
2) the characteristics of its Receiver Operating Characteristic (ROC) Curves
3) how cut-off points are calculated
I mention these at the risk of sounding pedantic because I want to encourage you to ask your GI doctor to walk you through these diagnostic statistics before the procedure itself. Taken together and properly explained, they tell you everything you need to know about colonoscopy.
posted by BadgerDoctor at 8:31 PM on October 31, 2021 [2 favorites]
1) the test's Likelihood Ratio
2) the characteristics of its Receiver Operating Characteristic (ROC) Curves
3) how cut-off points are calculated
I mention these at the risk of sounding pedantic because I want to encourage you to ask your GI doctor to walk you through these diagnostic statistics before the procedure itself. Taken together and properly explained, they tell you everything you need to know about colonoscopy.
posted by BadgerDoctor at 8:31 PM on October 31, 2021 [2 favorites]
Response by poster: Well, I'm on hour 3 and just barely starting to feel the evacuating effects... ugh
Thanks again all.
posted by bitterkitten at 4:10 PM on November 2, 2021
Thanks again all.
posted by bitterkitten at 4:10 PM on November 2, 2021
This thread is closed to new comments.
posted by telegraph at 12:46 PM on October 31, 2021