Dialysis and colonoscopy-preparation problem ...

[kristina]

Has anyone been referred for a colonoscopy? I am interested in the preparations for example “Clean-Prep” or “Movi-Prep”.
I was referred for a colonoscopy and on arrival I told them I could only manage 2.75 litres of water taking “Klean-Prep” (one sachet in a litre of water times x 4 which means four litres of water in 5 hours the day before the colonoscopy). It may be because of my small size and because I have not been drinking more than one litre to 1.3 litres of liquid per day since being on dialysis for the past nine months that caused me to only be able to drink 2.75 litres in 5 hours.
Unfortunately this was not acceptable and I was denied the colonoscopy  – they said in their experience “it” would not be clean enough as I had not completed the four-litre-preparation. I have been given another chance and for this they have prescribed “Movi-Prep” which only requires 2 litres of water. I don’t know whether I am right, but from what I have read “Movi-Prep” is a more violent cleaning-process than the “Klean-Prep” ... 
... Could this be why “Klean-Prep” is given to dialysis patients?  But how can it be managed to drink 4 litres of preparation-liquid within a few hours?
Would anyone know any tips on how to consume this quantity of water whether 4 litres-Klean-Prep or 2 litres-Movi-Prep?
"Klean-Prep" is a most disgusting liquid to take and it really did upset my stomach and eventually my whole body and it took time to recover and I missed having the procedure into the bargain... It may be easy for some people to drink so much liquid but for me I found it impossible to drink more than 2.75 litres... The colonoscopy is required before I am being put on the transplant-list... Any help in this direction or any thoughts or tips would be very much appreciated.
Many thanks from Kristina.

[Simon Dog]

I had Movi-prep.   The mixed solution tasted like bathwater, but was tolerable.  It is marketed as a "low volume prep".

The prep process is a shitty experience, but I would not describe it as violent.  Don't worry about going over your fluid limit - you'll pass it right through.

If you can, get the milk of amnesia (Propofol) protocol.  It makes the probe a lights out experience.

My neph advised me not to take the phospho soda prep.

[kristina]

Thank you Simon for your kind reply.
I wonder how your body took the Movi-Prep
and how long it took for your body to get "back to normal" after this experience?
I mention this because my body still struggles after the unfortunate Klean-Prep-experience...
Thanks again from Kristina.

[LisaBart]

My husband is not on really strict fluid restrictions...but they admitted him for the prep and he stayed another day after colonoscopy as it tends to throw your electrolytes out a lot.

[Athena]

Kristina,

I was considered for a colonoscopy 3 years ago and when I spoke to the gastroenterologist, I asked him for a 'kidney friendly' prep that was not the usual harsh prep that is given to everyone. I can't recall what it was but he specified some compromise type of prep that was designed for kidney patients in mind. Because I did not go ahead with the procedure, I didn't keep notes. But whatever your Neph tells you to take (or not take), is what I'd be following. You really need to make sure the colonoscopy doctor knows you're a dialysis patient.

I have recently read that some doctors are calling for a drastic relaxation of protocol concerning these preps. This whole 'clean bowel' operating principle apparently is not always strictly needed in all surgical procedures.

[Simon Dog]

Thank you Simon for your kind reply. I wonder how your body took the Movi-Prep
and how long it took for your body to get "back to normal" after this experience?

I was "back to normal" for a GI perspective as soon as the alien probe was done.

I did pass out on my couch for a few hours after being driven home, possibly due to either the anasthesia or getting up at an obscenely early hour to get to the hospital for the procedure.

Lucky me ... they found a small polyp which was removed, which means 5 years rather than 10 to the next one.

I asked him for a 'kidney friendly' prep that was not the usual harsh prep that is given to everyone.

Hopefully you can email your neph to get his/her approval of the prep.

Some procedures may not need a clean bowel, but I would want mine as clean as possible since the goal is for the GI doc to get a very good look at the entire intestinal wall.   You don't want a bit of turd obscuring something nefarious.

[Alex C.]

From personal experience, once you get past the first liter or so the rest goes through you like a freight train. Plan to be very close to a toilet for at least 6 hours.....

[cattlekid]

I am a member of the bi-yearly colonoscopy club since I’ve had ulcerative colitis since I was 19. 

Here’s my tried and true process for getting through the prep.

Supplies: 
One cup or glass that you won’t ever want to see again, preferably one that you can mark on with a marker
One marker
Your favorite chaser (some type of clear liquid with a distinct flavor that you like)
A timer
Reading material
Soft toilet tissue

Steps:
1.    Make up the prep.  Get it as cold as possible. 
2.   Figure out the volume of prep you need to drink per 15 minute time period to get your prep done in the allotted time.
3.   Mark that level on your cup or glass
4.   Chill the cup or glass
5.   When it’s time to start, channel your inner barfly.  Chug the prep from your cold glass then immediately follow with a swish of chaser.
6.   Set the timer for 15 minutes, put your glass and prep back in the refrigerator and forget about them until the timer goes off.
7.   Repeat steps 5 and 6.  After a few glasses, you might have to have someone start bringing them to you in the restroom. 

I was always told that as long as I am passing nothing but clear liquid, I didn’t have to absolutely finish all four liters but that may vary by doctor so check with yours.
Also, you may want to ask the doctor about using Dulcolax tablets as well to help with the prep so you don’t have to drink as much fluid.
The last time I had a colonoscopy, we did split prep where you drink part of the prep the day before and part the morning of.  I don’t know that I liked that as much but that may appeal to you and may be something that you would want to look into.

I agree with SimonDog that the “milk of amnesia” nap in the procedure room is  100% worth the price of admission.

[noahvale]

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[cattlekid]

I definitely agree that being first appointment of the day is the way to go.  That way, like you said, you can have a nice drug-induced nap, then a big breakfast and then home for a leisurely nap before being ready to take on the world for the rest of the afternoon.  They don't want you to drive for the rest of the day so I use the remainder of the day for puttering on projects around the house. 

I just looked up my pharmacy records from last year and I was prescribed PEG 3350 as well, plus the Dulcolax tablets to ease things along. 

Try to get the colonscopy scheduled as early as possible in the morning.  That way, won't have to go as long without eating.

And, yes, Propofol, IE the "Michael Jackson Drug," is best to have when going under for the procedure.  I came out of it very quickly and was ready to leave the hospital about 30 minutes after waking up.  I was famished so my friend and I went for breakfast.  Afterwards, home for a couple of hours nap, then good to go.  Much easier than I thought it would be.

What prep do you use?  My nephrologist was OK with PEG (polyethylene glycol) 3350 with electrolytes made by TriLyte.

[Simon Dog]

I agree with SimonDog that the “milk of amnesia” nap in the procedure room is  100% worth the price of admission.

Careful there.....  If you have to pay the premium for Propofol yourself, it is going to run hundreds.  Propof requires the services of an ane$theologi$t, whereas the fentanyl + versed + benadryl mixture does not.    I have the later as well as propofol, and it was also light out for me - but in the case of Fentanyl/Versed/Benadryl that depends on the dose and is not always the case like it is with propofol.

My nephrologist was OK with PEG (polyethylene glycol) 3350 with electrolytes made by TriLyte.

I believe Moviprep is one of the brand names for PEG3350

[cattlekid]

Good point.  You are right, I get the Versed combo and it is administered by the GI not a separate anesthesiologist.  Either way, it's a doozy of a nap. 

I agree with SimonDog that the “milk of amnesia” nap in the procedure room is  100% worth the price of admission.

Careful there.....  If you have to pay the premium for Propofol yourself, it is going to run hundreds.  Propof requires the services of an ane$theologi$t, whereas the fentanyl + versed + benadryl mixture does not.    I have the later as well as propofol, and it was also light out for me - but in the case of Fentanyl/Versed/Benadryl that depends on the dose and is not always the case like it is with propofol.

[noahvale]

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[kristina]

Many thanks to all of you who have so kindly contributed, it is very much appreciated and I am ever so grateful
for your kind thoughts and sharing of experiences.
What you have said here gives me so much more courage to prepare myself and undergo this ...
... I was just thinking how amazing it is what dialysis-people like myself are eventually prepared to undergo
in order to get their chance for a kidney-transplant...
... If anyone would have told me a few years ago that one day I shall be ever so keen to prepare myself for a colonoscopy,
in order to give myself a fair chance for a kidney-transplant,  I would never have believed it ...
... and here I am eagerly preparing myself for this colonoscopy which finally takes place next month...
... Times are certainly changing...

[Charlie B53]

I don't remember when it was that I had mine at the VA Hospital, I slept through it all.  They told the Wife that I am a Perfect A-Hole and not to come back for at least 10 years.

The VA sends out a gallon jug of Go-Litely Powder.  Fill the jug, down it all the night before the procedure.  NO solid food for 48 hours prior and NO COLORS, no dyes, Kool-Aid, Jello, etc..

I to used lemonade as my liquid to fill the jug and dissolved the Go-Litely powder which normally taste vile.  Doubled the Crystal-Lite Lemonade mix and it was only half bad.

I don't know what they put in my IV, only that it was to help me relax.  I slept, soundly.  Never knew when they started, or that they had even done anything until the Wife told me it was time to go home. 

OK fine with me.

I hope all goes as well with yours.

Take Care,

Charlie B

[Simon Dog]

... I was just thinking how amazing it is what dialysis-people like myself are eventually prepared to undergo in order to get their chance for a kidney-transplant...

Colonoscopies are not just for transplant candidates.

I had a polyp removed that could become cancerous.

My father (who is not a kidney patient) had a colon cancer discovered in a colonoscopy and it saved his life.

Anyone who skips the probe because they don't have a transplant team pushing them is taking a chance with their life.

[kitkatz]

My colonoscopy experience was pretty much as described by most of you, except results were inconclusive.  I have had bowel surgery from the age of 12 when part of the sigmoid was used for the urostomy stoma and he could not get the scope to go much further than that.  So God knows what they will do next.

[kristina]

Many thanks again Charlie B53, Simon Dog and kitkatz for your valid inputs,
it is very much appreciated and helps me to feel a little less nervous about this procedure ...
Thanks again from Kristina.

[Athena]

Krstina I actually forget to mention that I did in fact have a colonoscopy in about 2003. That was before CKD had reared its ugly head and I was oblivious to any concerns that you've raised in this thread. But I just wanted to let you know that it was a remarkably uneventful smooth procedure that hardly raised an eyebrow. I got a positive report from that and was told that I should be good for the next 10 years.

It's good to get these things out of the way. I wish you a lot of luck.

[Simon Dog]

Many thanks again Charlie B53, Simon Dog and kitkatz for your valid inputs,
it is very much appreciated and helps me to feel a little less nervous about this procedure ...
Thanks again from Kristina.

I am thinking WWBD?  (What Would Bob Northram do?) and the best I can come up with is waking up screaming "I was abducted by aliens and they gave me an anal probe!"