Colonoscopy Time Again -- I'll Call Some of the Shots, Please

It's time again for a routine precautionary colonoscopy; counting a simpler flex-sig over fifteen years ago, this will be my third. The history of colon cancer in my family is slight (one grandparent, at age 80) so I don't need the process too often. The last procedure went off without incident (save for a little problem negotiating one bend at the edge of the transverse colon -- easily addressed with a little manual pressure applied from the outside by an assistant), but as before, it's been agreed that I will be quickly sedated in the event of serious discomfort.

According to the MD, I'm only the second patient who's declined IV sedation so far this year.

The "prep" will be oral, but instead of the one-phase "GoLytely" used the last time around, the process will involve two doses-- one at 7:00 PM the night before, and the second twelve hours later. The option of a full colonic irrigation before the procedure (which, I'm told, is offered in some areas -- mostly Florida), was not discussed. I did tell the MD that I'd "embellished" the process with a bagful of soapsuds and glycerine the last time around (and started passing nothing but water and bile before half the GoLytely was down). Again -- no comment.

My accepting attitude towards enemas probably has its origins in hospitalization and major surgery (spinal fusion) as a ten-year-old; I spent eight weeks in a head-to-knees body cast and constipation was the natural result. But after a couple of ordeals with disposables, and young male interns who were as put off by the chore as I was, the MD in charge prescribed a "traditional" load of soapsuds from an irrigating can, administered by a pair of mature female nurses who explained the process and let me insert the nozzle and regulate the flow of water,

The difference was like night and day -- my resistance vanished, and perhaps not suprisingly, it wasn't necessary to resort to enemas as often to have a natural movement, But perhaps not suprisingly as well, I took an interest in enemas as I approached puberty a few years later, undoubtedly for the same reasons boys at that age no longer avoid bathing. To me, a traditional bag-and-hose enema is an "enhanced" part of personal hygiene -- same as a long, hot soak; pleasant, but not necessary on too regular a regimen.

I did a colonoscopy without sedation 3 years ago and it was surprisingly painful. It was the most painful thing I've ever endured but the pain was very brief. Once the bends were negotiated it was just somewhat uncomfortable. I was amazed how it hurt going through my sigmoid colon. I had had a flexible sigmoidoscopy in the past and that wasn't painful at all, in fact it felt good.

I did a couple of high colonics from a colon therapist two days and then the day before the proceedure as well as a couple of high volume enemas myself. Still I wasn't squeaky clean and embarassed to see fecal matter on the display screen as the Dr was pushing the scope deeper. But the colonics were far better than the golightly stuff.

I will definitely do my next colonoscopy without sedation. The pain is over quickly. The wonderful after effect was that I was so high on endorphins afterward, that I had a wonderful time once I got back home.

Well, the plot thickens.

I had a consultation with the MD in charge earlier this week, As I said previously, the procedures for "prep" have apparently been tightened -- at least for the majority of the public who are more sensitive about such issues.. I went in to pick up the prep kit, and was unpleasantly suprised to find a $90 charge as part of the deal -- not covered under Medicare 'D' because all the '"ingredients" involved are available over-the-counter.

Fortunately, I have a very close friend of nearly thirty years standing who is a pharmacy tech; so I got back in touch with the endoscopy center, and have apparently convinced them that I learned enough about the practice during my hospitalization years ago to do my own prep with a somewhat "lighter" kit -- and probably a little extra help from a technique and devices with which most of us are familiar.

So I suspect I'll be able to discuss the issues involved in greater deal at "the main event".

Regarding the prep (and other necessities of life), if a person is alive, there are things they have to pay for. In your profile you said you hold to strong conservative/libertarian economic values, so having to pay for your prep materials should not come as a surprise. Besides, that also means you aren't paying for anyone else's prep materials.

Keep in mind the doctor doesn't have to treat you if he doesn't want to and if he feels the prep has not been good, he will discontinue the procedure, bill you anyway and you will have no test results.

Thanks for the cautions, Susie! the discussion with the MD handling things was frank, but respectful. They have agreed to supply me with a less-expensive prep kit (according to my pharm-tech friend (whom I've known for almost thirty years, and who went to bat for me on this). my original inquiry was only in regard to the lack of coverage for the over-the-counter prep, but she apparently convinced them that we're both familiar enough with the issues (and procedures).

MD's and drug salesmen sometimes tend to "schmooze": in some instances like this, but I'm confident that I can do a clean prep with the second-tier stuff (did a "traditional;" enema last time around, and was passing nothing but bile and clear returns before half the GoLytely had been chug-a-lugged -- though I finished it anyway, and got an "attaboy" on the thorough prep. As previously mentioned, I was unsedated and had a front-row "seat").

The prep kits at the pharmacy are outrageously expensive.

Start with only clear liquids the day before; there's less to clean out.

A very good home-brew solution is to use 2 qts of Gatorade-no red/purple color permitted-with 4 Oz (wt) of miralax or ClearLax (The latter is a generic and much cheaper). A full bottle of ClearLax powder is about 8 ounces; pour it all into a large measuring cup and mix half with the Gatorade. If you wish, add a 1/2 tsp of bicarb to the mix. Drinking it through a straw will reduce the need to chill it; it will taste mostly like Gatorade. The straw takes some of the flavor sensed by the nose out of the equation. It works! Have used this myself for a colonoscopy prep. Take two 5 mg Bisacodyl tabs and wait until the first bowel movement (I waited only 2 hrs), then drink the first two quarts over 1/2 hr or so. Do two rounds of Gatorade 2 qts/4 Oz. clearlax.

I wanted to complete the prep the DAY before the procedure; I started at 07:00, and took a second two qts at about 5:00PM. By not chilling the liquid, I avoided freezing myself. Starting early allowed me to get a good night's sleep. I had followed the Dr.'s instructions in the past and soiled the bed and stayed up pretty much all night shitting. The constant drizzling shits is enough of an insult; soiling the bed was absolutely humiliating. NEVER AGAIN!

The prep worked well; good visualization of the colon and an easy exam.

Here is an new mode of examination without the terrible snake.

It sounds more reasonable and possibly more revealing in some ways.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675246/

I had my most recent colonoscopy two weeks ago. My GI doc uses Miralax --- 1 bottle into 54 oz of Gatorade, plus for dulcolax tabs. It is a relatively comfortable prep, compare with ones I have had before. He does a a two round prep --- one the afternoon before (with 2 of the 4 dulcolax tabs and half the solution, taken every 15 minutes) and one 3 1/2 hours before the procedure. The only problem I have with his method is I schedule the procedure for 7:30 am, which means I get no sleep for over a day.

Here is an new mode of examination without the terrible snake.

It sounds more reasonable and possibly more revealing in some ways.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675246/

The downside of any of these (as I've had it explained to me) is that if they find anything then they have to go in with an endoscope anyway. I don't know about "most people," but it seems as though in my family they're cutting stuff out every time on my dad, less often on my mom.

Knorris, et. al.

Over-the-counter (OTC) products are NOT covered by prescription plans, so your expectation was incorrect and baseless. Those who are not on Medicare (as you are, re: your reference to "Part D") may have a Health Savings Account (HSA) which CAN be used to reimburse [covered] OTC purchases. Perhaps you had one of those before aging into Medicare.

Pharmacies are for-profit businesses and certainly know how to exploit consumers who are unfamiliar with various prep products and protocols. Many, but not all, practices package prep kits as a convenience for their patients and are not allergic to making some money, too. Those who plan (or call) ahead may find that options and prices are both better via the internet (Amazon, etc.).

DIY protocols may or may not be a safe way to go. There are certainly many well-informed non-professionals here, as well as some actual professionals. And, a little bit of substitution/mix-match may be OK. However, the physiologic effects of various combinations of laxatives and purgatives are not entirely generic, as individual medical history, prescriptions drugs being taken, (in)sensitivities to certain products, BMI and other factors should be considered by a knowledgeable professional. This is the wrong assignment for amateurs.

Of course, in the end (pun intended), you'll be the beneficiary or victim of your own decisions.

Of course, in the end (pun intended), you'll be the beneficiary or victim of your own decisions.

I swear, if you guys don't STOP making those stupid puns, you are going to be fucking punished.

Susie,

Promises, promises . . . . . !!!

I just had my latest colonoscopy - but for the first time in my experience I was barely adequately prepped. I have never had such problems getting clear.

I was prescribed Suprep and followed the instructions to the letter, but was still passing muddy returns at midnight. My scope was scheduled for 8AM and I was concerned that I would be told I was unable to go through the procedure. The thought of another day of Jello followed by "sewage prep' prevented me from sleeping well and I woke at 4:30 to another muddy BM.

The endoscopy practice I used has a 24-hour on-call number for folks who have problems before or after their procedure and at 5AM I called and left a message and my number. A woman returned my call in minutes (remember this is 5AM) and I explained the problem. My wife was sitting next to me and had me put her on speaker. The nurse asked if I had followed the prep and I answered truthfully that I had. She told me I could either reschedule and try another prep like Trilyte and I would not be charged for cancelling, or I could try to get clear between then and 7AM - when I would have to leave the house to get to their office.

I said I would prefer the latter - not wanting to repeat the prep. She asked if we had Fleet enemas in the house and my wife answered and said we did not. She asked if our town had a 24 hour Walmart or drug store and I said the nearest was 30 minutes away and not really an option.

She then asked if we had an enema bag in the house and I answered that we did and she seemed surprised. She actually said "You do??" My wife chimed in again said "yes, of course."

She then said I would need to take a warm tap-water enema of about two pints. If that did not produce clear return - something like the color and clarity of urine, that a second enema should be taken. My wife said that would be no problem - she would make sure I was good and clear. Jokingly the nurse said to my wife that her husband would leave her if she ever approached him with an enema!

Before hanging up, the nurse asked if I had any questions and wished me luck.

My wife said two pints is what a ten-year old gets in an enema and filled the bag to the brim and proceeded to give me three no-nonsense enemas over the next hour. I was still passing yellow water with an occasional 'pebble' in the returns and was concerned after three enemas that I still would not pass because of the fecal pebbles but went off the office.

The scoping went well, although some of the pebbles were evident - the doctor said they were in the diverticular pockets and are not easily dislodged by laxatives or even enemas. Even the water stream from the scope did not chase them all out.

Has anyone had a similar experience? These fecal pebbles did not cause infection - they just did not get cleaned out! I wonder if a colonic would have been effective?

Had to delay that colonoscopy for nearly a year due to several factors -- primarily a fender-bender auto accident that revealed some other health issues, but I finally got around to it last August, and got permission to use the prep kit the previous hospital had furnished; no unusual conditions were noted, save for one discoloration (biopsied, tested and found benign) and that I'm developing diverticulae (not that uncommon at "my age"). The three-person crew in attendance was all-female; I had one anxious moment when the scope appeared to "catch" on something (but it lasted for only a fraction of a second), and I was again complimented on the effectiveness of my prep.

As someone who is currently in chemotherapy for rectal cancer, let me offer a PSA: do the colonoscopy folks. It' s FAR more pleasant than the treatment for cancer.