what to do if bowel prep doesnt work
Dear Retroflexions,
Hello, this is a note for Dr. Gandolfo. My name is (proper name redacted). We have never met; nosotros don't know each other. I'1000 not a patient; simply I just so enjoyed your post A Gastroenterologist Cheats, etc. and I wanted to cheers and comment on it.
I am sure you lot are a super-decorated dr., but if you take a few minutes to read this, I would really capeesh information technology!
It is right now, really 12:38 in Seattle, where I alive, and I am correct in the midst of prep myself. And then hither I am and thought "Oh I will read upwardly some on the procedure and prep while I'm waiting to practise the second dose of Golytely" (or whatever information technology'southward called).
It was interesting to me how you considered how hungry y'all become every morning upon waking, and that you lot asked yourself, 'could yous survive on eating nada but clear liquids, and still do your job?' And so, yous had some yogurt, white bread, etc. I get hungry besides upon waking, and I am a physically super-active person. And I think, in medicine in general, that patients will read instructions, or heed to their doctors, and then they will "tweak" whatever is said and consider how it fits into their lives.
I counsel many people, mostly women, on changing their lifestyles or diets to adapt to some wellness issue. And I find how important it is to listen to people, and find a manner to integrate whatever the requirement is, into their lives. Not just to tell them "cut out carbohydrate" etc. Merely to discover options that might work to encourage compliance.
Anyway, I don't know if you telephone call it cheating or non, but I adjusted the prep and this is what I did (see below). Only at present? I did my first dose of the divide dose of the Golytely prep thing at 6:35 pm in Seattle. Now it is 6 hours later. SIX HOURS. And no reaction. Nothing. No balk, no going, nix. Absolutely zip. That is weird. I was so filled with anxiety about this whole thing. I was expecting to exist "running," but "nada!"
So, what did I eat or how did I cheat at all? Over the weekend, what I ate on Friday and Saturday were eggs, obviously yogurt, white staff of life, a trivial peanut butter, banana, and absurdity. This is "totally and entirely" different than the fashion I usually consume. I never ever swallow a low-fiber diet, I generally don't eat bread, nor banana. Simply I did it…kept it low-residue.
Over the course of Sun morning, earlier 11 am, had three cups of whey protein drink mixed with water. Since then I had all clear liquid, Gatorade, apple juice, white grape juice, a little java. That is all I had Sunday.
It's now Monday, a bit after midnight. I don't know what's going on, and I'm not asking for medical advice, only chatting and sharing to say I cheers for your post. I know a lot of doctors volition work in certain fields, merely and so they don't always feel what they really do.
I had a very shut friend who was a physician. Yet he knew nothing about what to exercise when he was diagnosed with blazon 2 diabetes. And then he had to ask me what he should consume. I become it though, simply because a doctor is a doctor doesn't mean they have first-hand experience with every situation. The knowledge they accept is either learned in school or through patients, but non necessarily first-hand.
That'south it. Thanks for your post,
(proper name redacted)
P.S. Hoping something happens 2d dose?
Thank you for the interesting letter! From what you wrote, I'chiliad hoping that the starting time dose kicked-in by the time you were fix for the second dose and everything, um, "came out" OK! Information technology seems like you lot did a proficient job at following a low-fiber diet for a few days leading up to the prep, and did not eat whatever real food the day before the process. The prep should eventually work. Anybody processes bowel prep at dissimilar rates. If your normal bowel habits tended towards constipation information technology may take a little longer to make clean out, but merely in very extreme cases* does severe constipation lead to absolute failure of the bowel prep.
Sometimes if I am planning on a colonoscopy and I know the patient is on the constipated end of the spectrum, I will ask the patient to take a x mg dose of Dulcolax (bisacodyl) the morning earlier the procedure, several hours before starting the liquid bowel prep. This will often "kickstart" the bowels and when it'due south fourth dimension to drinkable the existent prep everything works much nicer.
But what if it's too late? If you lot're reading this while in the midst of a potentially failed bowel prep don't despair! There are many ways to salvage a bowel prep and still have a rubber, loftier-quality colonoscopy the next twenty-four hour period. It all depends on what fourth dimension yous take activity; If you wait until 2 hours before the procedure is scheduled than yes, it's probably too late to do much. All the same, if you lot're already having issues the dark before you lot can totally recover from this and be fine. This is what I usually recommend:
"I drank the get-go dose of the prep and nothing happened." I ordinarily tell patients to expect a several hours before panicking. If you lot are similar the to a higher place patient and have waited vi hours and in that location is no bowel action any and so at that point I would recommend taking either x mg of bisacodyl by oral fissure, or giving yourself an enema. If y'all've done all that and still goose egg then it's probably time to call your dr. and ask for suggestions.
"I drank the first dose of the prep just vomited well-nigh of information technology up." Unfortunately, you will need more prep and so. This usually requires a phone call to the doctor explaining the upshot and often an alternative prep is recommended. In selected patients, I would unremarkably recommend Miralax prep or using magnesium citrate instead–both of which can exist purchased over the counter.
"I tin't drink the commencement dose of the prep because it tastes horrible! Yuck!" Endeavor putting the prep in the fridge and making it as cold as you tin tolerate. Much of the taste disappears when you really arctic the prep. You can also call your doctor to see if an alternative prep is an option for you. Ultimately this is also a instance of mind-over-matter…it'due south unpleasant but sometimes you just take to do it anyway!
Want more than? Cheque out my video on how to practise the colonoscopy prep THE Correct Manner!
"I drank both doses of the prep and my bowels are still non articulate" This is a mutual issues with some bowel preps. It really depends on what time this happens. If you did all the prep the dark before, then at that place is enough of time to follow the prep with a canteen of magnesium citrate and a large volume of clear liquids. If yous notice that you lot are non clear the morning of the procedure, you can still potable magnesium citrate only really need to finish drinking it nigh 4-five hours before the process is scheduled to commencement. This gives it plenty time to have an effect, and besides keeps you well within the ii hours safety window for ingestion of clear liquids with respect to receiving anesthesia. Still, if the process time is shut (2-3 hours away) and you're all the same not clear, and then the only real option is to give yourself an enema or 2. You tin ever reschedule the procedure if you have to, but realize that you already completed the bowel prep and volition therefore have to do the entire prep once more if you need to reschedule!
I am glad that I have first-paw knowledge of bowel prep and can help my patients through the feel, but only for the record I am non stating that all gastroenterologists demand to subject themselves to the joys of a bowel prep just to see how it works! If we applied that logic to other specialties nosotros would accept surgeons getting their gallbladders removed only for the experience, oncologists getting chemotherapy for no good reason, and anesthesiologists experimenting with some serious drugs all in the name of science. Probably not the best thought (unless you ask the anesthesiologists…just kidding)! I do understand what you are proverb however…it definitely helps me role meliorate as a gastroenterologist having been on the other side of the scope 🙂
*Extreme cases such as severe chronic slow-transit constipation, previous abdominal surgery, bowel adhesions, strictures, or obstructions, opiate pain medication use, and patients with a history of fecal impaction to name a few.
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Source: https://retroflexions.com/the-informed-patient/letter-what-to-do-when-the-colonoscopy-prep-doesnt-work/
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