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The Colonoscopy Thread: a PSA

VRBeauty

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I'm expecting this one to be a real winner! ;-) OK, maybe not.

Seriously, I recently ranted about having to prep for a colonoscopy in the rants/vent thread, which started a conversation about prepping for colonoscopies... and then decided it might be better to continue that conversation elsewhere. Like here. Because it turned out my prep was actually pretty easy and not really rant-worthy, and because I wanted this information to be easy to find.

So... I underwent a colonoscopy a few weeks ago. It was my second in five years. (Technically my first, since the previous test was a sigmoidoscopy, kind of a "colonoscopy lite.") As I understand it the usual protocol is that routine colonoscopies or sigmoidoscopies start at around age 50. If nothing adverse is found, you won't have to repeat the test for five (sigmoidoscopy) to ten years (colonoscopy).

If you've had a colonoscopy or heard about it, you already know that it's the day before the procedure - the "prep day," that many people dread. Basically you take a prescribed regimen of laxatives to help you empty your intestines, you're starved on a clear liquid only diet, and you spend a lot of time on the toilet. If the prep is not done well and there's material left in the colon, the test may be aborted and repeated later... after another prep day. If that isn't incentive to get it right the first time, I don't know what is!

My previous prep day was a day of total discomfort, so I wasn't looking forward it this time. But as I mentioned above, this time the prep was not bad at all. Inconvenient, yes, but not terribly uncomfortable.

So what changed from five years ago to this time?

The hospital prescribed a different laxative regimen. I don't know what role that played, however.

This time the instructions also suggested that I start changing my diet a few days before the official prep day - and I suspect that made a lot of difference. I followed the hospital's instructions, which suggested cutting out nuts and seeds, and leafy green veggies in the days leading up to the preparation. I suspect those instructions are designed to ensure a cleaner colon for the day of the colonoscopy, but - they seem to have a side effect of making the cleanse easier. Also I'm retired now, and generally eating smaller and fewer meals, and less meat in particular.

In the vent thread I mentioned a blog posting I had found about preparing for a colonoscopy that included a lot of good information. Unfortunately I didn't stumble on it until the day of the prep, as I was researching the question of whether it's OK to eat gummy bears on prep day (some sources say yes, but my doctor's office said no). But the first several several hours of my prep were "business as usual" and I was still able to run to the store and pick up a few things. Here's a link to the thread. Be forewarned that it presents a worst case scenario picture of prep day, and they're not necessarily all that bad. Mine wasn't.

http://www.cancer.org/acs/groups/content/documents/document/acspc-042280.pdf

So what do I think is most important?

Pick up your prep kit several days before you start your prep, and read the instructions carefully then. Don't assume they'll be the same as the instructions you might have followed for a prior exam - mine were not. Call the doctor's office if you have any questions. (My doctor's office called me a few days before and the day of the prep to see if I had any questions.)

Start modifying your diet two or three days before your prep day, both by eating less and eating more easily digested foods. (Google "Low Residual Diet" for lists of easily digested foods.)

I made myself a nice rich broth to slurp on prep day. If you do that, cook it carefully, at a low simmer rather than a boil, to keep it as clear as possible; use vegetables that won't fall apart easily, and cut the veggies into large chunks. No tomatoes or beets, of course! (Anything red remaining in your colon could be incorrectly interpreted as blood.) What I learned? I used lots of mushrooms, not knowing that the"gills" would cause the broth to be brown and opaque. I was able to filter it reasonably well (it wasn't easy) but next time I'll use younger mushrooms or just cut off the gills, and have cheesecloth on hand, just in case, to help clarify the finished product.

Ensure (a protein/food supplement drink) now comes in a clear formula called "Ensure Active" that's very palatable. I used this as part of my meal substitution on prep day.

I prepared a small box of Jello for my prep day, but next time it'll be a large box for sure! When I made the jello, I used ginger ale instead of cold water to make it more interesting.

I really appreciated my wonderfully fragrant luxury soap that day! You'll be washing your hands a lot, so if you who appreciate nice soap and hand lotion, this is the day to bring them out! (A nice scented candle, too.)

My prep instructions called for me to drink a liter of prep liquid over a one-hour period, three to four hours before the scheduled procedure time. When I saw this, I rescheduled my procedure from first thing in the morning to late morning/early afternoon. I'm not an early riser, and I decided I'd rather be hungry for a few hours more than to have to get up at 4 or 5 am just to drink a gallon of cold liquid. (As it turned out, hunger wasn't a problem.)

Speaking of the liters of prep drink... I really appreciated the flavored powders and drops now available to spruce up bottled water!

I was put under "conscious sedation" for the colonoscopy but really, the next thing I remember clearly is waking to a call from the doctor, a good eight hours or so later, telling me that the colonoscopy showed no problems and I was good to go for another ten years! :appl: In other words, don't make plans for the afternoon or evening of the colonoscopy! (When I underwent the sigmoidoscopy a they used a lighter form of sedation in which I was basically aware of the procedure and able to talk to the techicial and respond to instructions throughout. Although the discomfort wasn't terrible, it was there and I was aware of it. I don't recall if I slept away the remainder of that day. I also know someone who underwent a colonoscopy without any sedation because he hadn't arranged for someone to give him a ride home. Like any of us friends wouldn't have been happy to help out! :roll: But he did live to tell the tale!)

So there it is, the colonoscopy thread. I hope someone out there will find it helpful.
 

kroshka

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Very informative - thank you for posting your experience and suggestions!

Kroshka
 

boerumbiddy

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I had quite complicated diet instructions from my doctor for up to a week before the procedure. By a couple of days before, it was nothing but white bread,turkey, cheese and Rice Krispies, as I recall. I am sure that made it all easier.
 

chemgirl

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I have a rare form of colitis so had my first colonoscopy last year at 30.

If I have any advice to add it would be to buy the expensive toilet paper. Lots of um...irritation... You don't want to be using the scratchy stuff. Also wear yoga pants or something similar. The key is to have an elastic waist. You don't want to be fiddling with buttons and shimmying out of tight jeans once the prep kicks in.
 

VRBeauty

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chemgirl|1414722125|3775287 said:
I have a rare form of colitis so had my first colonoscopy last year at 30.

If I have any advice to add it would be to buy the expensive toilet paper. Lots of um...irritation... You don't want to be using the scratchy stuff. Also wear yoga pants or something similar. The key is to have an elastic waist. You don't want to be fiddling with buttons and shimmying out of tight jeans once the prep kicks in.

Ahh, yes. And dabbing or patting rather than rubbing whenever possible. The blog post recommends moistened towlettes but home's sewer system wouldn't like that, so I used moistened toilet tissue when necessary.

I'm sorry you're starting the colonoscopies so early. I hope they turn out to be few and far between!
 

azstonie

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Former hospital/clinic employee here (Mayo):
1. Use fragrance free baby wipes um instead of toilet paper. In fact, GI and Colorectal docs feel toilet paper and coarse sandpaper are one in the same. Most city utilities purchased shredders just for baby wipes in wastewater.
2. Be aware that the scope/associated tools are *not* sterile. They are scrubbed and cleaned by techs and reused.
3. Be the first appointment of that day for 2 key reasons:
A. That is the cleanest that room will ever be and
B. You will not wait and wait for your procedure, nauseous and cold and nervous, because the colonoscopies before yours ran late.
3. Have your procedure on Monday or Tuesday because if you see are the 1:1000 to have a perforation you won't have to present for repair on the weekend and you'll be able to contact your doctor.

This is a really kind thread by VR (did not know about the clear Ensure, good to know)!

For people with no alarm symptoms or prior history of polyps, the new Cologuard test is 92% to 94% accurate at detecting tumors throughout the colon and rectum. The test is DNA assay, covered by insurance, and is not invasive (poop collection only). The test is as effective at finding polyps as colonoscopy but without risk of perforation, infection, and several days out of your routine.

There are also several imaging tests that can screen for polyps.

If you have polyps found on any screening, you still wind up with a scoping procedure so the polyps can be removed.
 

VRBeauty

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Thanks for adding your expertise, azstoie! Those are all good (and somewhat :o ) things to know!
 

azstonie

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:wavey: it's a great thread you made, the info I got on colonoscopy was minimal, nothing as good as you had. I went to the head nurse/colonoscopy division and she told me what I posted.

Yeah, #2 is just, well, awful. I think it was born out of penny pinching but I don't know for sure. It's a real risk, lots of people having colonoscopies have C diff, super C diff...

Also, for the petite people here, you can always request a pediatric scope be used.


Aaaaand no residents, you want experience rooting around your heinie, frankly.

Aaaaaaaaand have the endoscopist promise you that if it's difficult getting to your cecum (redundant colon, whatever) they will stop rather than risk a perforation.

Okay that's all I got!!!!
 

movie zombie

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I so love this thread!
seriously!

I have my 2nd colonoscopy on December 22.
I have stared to get my supplies readied.
dr has prescribed MoviPrep and I've got it here at home so I can read, re-read and then read again all the info.
they've got a decent website: http://moviprep.salix.com/

I swore after the first one 7 years ago I'd not do it again.
there were some polyps with nothing "negative" but the prep experience was so bad I just couldn't face doing it again when the recommended 3 year re-exam time rolled around.
I met with a gastro dr and she said her own mother with the same results made the decision to wait until year 7.
so here I am at year 7 prepping and hoping for at the least a less sore "rear end".

the MoviPrep "cleanser" seems to be an improvement and with the help of this thread I hope to have a better experience.

sigh.
 

azstonie

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Hi Mo Zo:

I've been told the MoviPrep has a greasiness to it, just to let you know. Also, the dose is body weight dependent, so you may not have to choke all of it down.

Good luck!!!!!!
 

Ara Ann

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azstonie|1414898089|3776211 said:
For people with no alarm symptoms or prior history of polyps, the new Cologuard test is 92% to 94% accurate at detecting tumors throughout the colon and rectum. The test is DNA assay, covered by insurance, and is not invasive (poop collection only). The test is as effective at finding polyps as colonoscopy but without risk of perforation, infection, and several days out of your routine.

There are also several imaging tests that can screen for polyps.

If you have polyps found on any screening, you still wind up with a scoping procedure so the polyps can be removed.

This is a timely post! My husband just had his yearly checkup on Wednesday, he just turned 51 and has never had a colonoscopy. I thought sure his Dr. would schedule one for him, but he instead prescribed this stool sample testing. I had never heard of this before and am wondering if it is a good alternative for a colonoscopy? He hasn't had any symptoms or colon issues...as uncomfortable as a colonoscopy is, for peace of mind, I'd kind of like him to have one done as a baseline, to rule out anything abnormal from the get go? Or am I being overly concerned? I realize no one can give medical advice, but again, I'd not heard of this before so would like some other opinions to go on.

Thanks!
 

VRBeauty

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Ara Ann:

Here's an article about the accuracy of thestool sample test:

http://www.webmd.com/colorectal-can...olon-cancer-called-accurate-but-not-foolproof

I'm with Kaiser, and I think they're using these tests as screening tests between colonoscopies. I didn't think they were using them instead of colonoscopies, but I could be wrong, especially since these are apparently a newly accepted tool and my first procedure predates some of the studies cited in the article. I'm sent one of these tests every year. This year I was late sending it back and I was hounded with phone and mail reminders. :lol: I had to go in for my colonoscopy earlier than the 5- 10- year schedule would indicate because of blood found in a sample using one of these tests.
 

JewelFreak

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I had a colonoscopy about 10 yrs ago without anesthesia. The prep was torture & the procedure so icky I will NEVER have another one. Not for anything. Not ever.
 

azstonie

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Okay, re stool sample screening:

there is a simple stool test that only screens for the presence of occult (hidden) blood. Usually a doc does it after your rectal exam during a physical. Results are immediate. IT ONLY DETECTS GROSS BLOOD. They also used to send ya home with these cards so you could do it at home.

The Cologuard Test was developed and tested by Mayo Clinic. It is a DNA assay test not a test for gross blood, IT DETECTS TUMOR MARKERS.

Regarding your husband, the decision points are in the first posting I made. 51, no symptoms, no first degree relative with colon cancer if he were my husband I'd have him start with Cologuard. If it comes back positive for tumor markers, he will have the colonoscopy to remove polyps/tumors. If no tumor markers, can do the screening interval that his doctor feels is advisable.
 

Ara Ann

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Thanks for the reply and advice (I will check out that study too!)...I need to look at the packet and see which test he was given. I'm pretty sure the Dr. had told him it looks for blood though. If that is the case, I can't imagine his Dr. recommending this test in lieu of a colonoscopy. If it is the other one, then I do feel better about forgoing the colonoscopy - amazing that it can detect tumors this way!

Thanks again!!!! =)
 

movie zombie

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JewelFreak|1415380903|3779249 said:
I had a colonoscopy about 10 yrs ago without anesthesia. The prep was torture & the procedure so icky I will NEVER have another one. Not for anything. Not ever.

OMG, I forgot about that one....I too had one w/o anesthesia!
yes, they had to stop because I was in so much pain when they tried to get past some narrow section!
the only "fun" thing about that one was I could watch the screen and see the interior of my bowel as they were doing it...yes, it was interesting and yes I know i'm weird but i'd rather find something "positive" in what was a not so nice experience.

so, this will be my third one on December 22.....oh, joy joy.
 

JillyC

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I had one a few years ago. The prep really was the worst of it, for me. Hard to choke that stuff down (Suprep). Other than the need to use the bathroom frequently for several hours and then having to get up early to repeat, I din't have any other side effects from it. The procedure itself was nothing, the anesthesiologist said "sweet dreams, see you in recovery" and that was that.

Waiting to hear the results from the doctor was hard, though, as my older sister had just been diagnosed with colon cancer and I was worried, but for me, all was fine.

I would definitely recommend anesthesia, unless you have problems tolerating it. I had no desire to participate further than just being there.
 

zoebartlett

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I have a few questions...

A prep day consisting of Miralax, Ducolax, and yellow or green Gatorade is considered pretty good, right?

Any tips for dealing with anesthesia (Propofol) for the first time?

Is it overkill to eat a lighter diet (BRAT -- bananas, white rice, applesauce, white toast) 1-2 weeks before beginning the mandatory liquid diet 3 days before the procedure?
 

missy

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Hi Zoe, I cannot answer your other questions having never had a colonoscopy but I can answer your Propofol question as I was given that during both endoscopies this year. There is nothing to do for that and it is really quite a pleasant anesthesia that has gotten a bad rap from its abuse. Given in correct quantities you wake up from it feeling very well with no hangover whatsoever. Of course the anesthesiologist will ask you if you have any allergies to meds but Propofol is really a good anesthesia for short medical procedures. Good luck and I hope it all goes smoothly and easily for you with good results!
 

Gypsy

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This is a great thread VR.

I haven't had one myself. But my husband has had two. The first one... OMG, the prep day and night before were a nightmare. They proscribed him so many laxatives and it was overkill. He was so violently ill that I was frightened and with his back, after several hours in the bathroom, he could barely walk.

So of course, when he had to have one this year we were apprehensive. But it was totally a different experience. The prep was very reasonable, and the medications were just enough to get the job done but not so much that he needed a seat belt for the porcelain throne.


I am glad you had a much better experience as well, the second time around.
 

momhappy

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JewelFreak|1415380903|3779249 said:
I had a colonoscopy about 10 yrs ago without anesthesia. The prep was torture & the procedure so icky I will NEVER have another one. Not for anything. Not ever.

While I can appreciate the ick factor - it's better than colon cancer…. A good friend of mine was just diagnosed with colon cancer (early 40's, father of three). Unfortunately, the cancer has already spread to his liver, so his prognosis is definitely not as good as he had hoped when he was initially diagnosed. Now he's facing several rounds of chemo in an effort to get the cancer to a point where surgery can occur. I'd rather suffer through a colonoscopy than a cancer diagnosis.
 

azstonie

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Zoe|1418681484|3801719 said:
I have a few questions...

A prep day consisting of Miralax, Ducolax, and yellow or green Gatorade is considered pretty good, right?

Any tips for dealing with anesthesia (Propofol) for the first time?

Is it overkill to eat a lighter diet (BRAT -- bananas, white rice, applesauce, white toast) 1-2 weeks before beginning the mandatory liquid diet 3 days before the procedure?

Hi: Those laxatives you mention above, I've never known them to be used for colonoscopy prep. The colonoscopist includes in his report his evaluation of the quality of the prep (poor, fair, good, excellent) in order to frame the reliability of the colonoscopy. If most of the colon is obscured by stool, food etc the results are not reliable and repeat colonoscopy is therefore recommended.

Clear liquids only, they need to evaluate the color and quality of your mucosa.
 

VRBeauty

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Zoe|1418681484|3801719 said:
I have a few questions...

A prep day consisting of Miralax, Ducolax, and yellow or green Gatorade is considered pretty good, right?

Any tips for dealing with anesthesia (Propofol) for the first time?

Is it overkill to eat a lighter diet (BRAT -- bananas, white rice, applesauce, white toast) 1-2 weeks before beginning the mandatory liquid diet 3 days before the procedure?

Zoe: When you schedule your colonoscopy, your doctor will prescribe a laxative regime. The first time I had a colonoscopy, I was sent a list of over-the-counter medicine to buy and instructions for using them on the day of the cleanse. (There were two of them: some laxative pills and an evil-tasting liquid that you can buy without a prescription.) The second time, I was given a prescription for a prep kit to be picked up at the pharmacy - this consisted of some pills and a powder that was to be mixed with a gallon of water and drunk at prescribed intervals. Whichever option your doctor uses, you'll be told exactly which laxative(s) to take and how and when to take them.

You'll only have to restrict yourself to a liquid diet for one day, the prep day itself. The goal is to make the prep day itself easier and as effective as possible, and my experience suggests that restricting your diet for the two or three days leading up to the prep day is enough for that. The blog post I mentioned earlier (https://eatitandlikeit.wordpress.com/2014/03/16/the-straight-poop-an-awkward-conversation/) suggests that it might help to switch to a low residue diet earlier if you normally eat a very high fiber diet - i.e. if you eat close to a vegetarian or vegan diet. The "BRAT" diet is one option for those restricted days, but if you google "low residue diet" you'll see a much wider (and probably healthier) selection of foods to choose from that will accomplish the same thing. Keep in mind that your body needs the fiber and such that you won't be eating on a low residue diet, so you don't want to adhere to those restrictions for longer than you need to. I can't recall whether I was told to limit red foods (such as beets, which Iove!) during the days leading up to the prep... :confused: but I think that was part of the instructions I was sent. On the prep day itself of course you definitely want to stay away from anything red.

Good luck!
 

zoebartlett

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Thanks Missy, VR and Azstonie!

VR, it's the second option you listed -- OtC meds, powder, and liquid (Gatorade, not water though). I was super psyched, well, as psyched as one can get with this, that it wasn't some horrible tasting prescription liquid. I can handle Gatorade, but man, it's a LOT to down in such a short amount of time.

My clear liquid diet begins every hour the morning before at a certain time and lasting until bedtime, and ends 3 hours prior the day of. There's a ton of directions, but essentially, it's making sure to take the meds at the directed times and drink 8 oz. every hour. Afterwards, I'll have to drink 6 more 8 oz. of clear liquid until bedtime.

The weird thing is not knowing what time I'll be going in. Apparently the hospital calls the day before (in my case, the Friday before), once they get their schedule figured out. I had originally asked for the earliest time available, but now I'm second guessing that request since I may have to get up ridiculously early to finish the prep.

All I have to say is, I'm really happy that I'll be on vacation from work while this all goes down.I'm sure I'll be happy once it's done but I'm REALLY not looking forward to it.

Oh, and will they still do it if you have a cold? I feel a bad cold coming on and not being able to breathe, plus feeling nervous/awful, spells disaster in my mind. I mean, not that a cold is related to this at all, but would there be some sort of problem administering the anesthesia? Silly question, but just thought I'd ask.

:knockout:
 

House Cat

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My 20 year old son was diagnosed with Crohn's disease at 8 years old. He has had several colonoscopies and more sigmoids than I even can even count. He hates the anesthesia, so he does the sigmoids without. He figures it just isn't worth the side effects.

Each time he has had a colonoscopy, they have had him prep differently! I think it has to do with the preference of the doctor. One time it was large doses of Milk of Magnesia. A couple of times it was a prescription. Another time, I remember two bottles of a carbonated laxative that you pick up at the drug store. He is having both an upper endoscopy and a colonoscopy on the 29th, and he has been prescribed a gallon bottle with powder in it that we have to mix. Then he has to drink that gallon of fluid throughout the day prior to the scopes.

When he was really young, prep days were really tough. I would usually go out and buy him the best video game that I could find for distraction and rent a bunch of movies. That is the principle I am sharing, which has already been shared, but can't be stressed enough, treat yourself as best you can because prep days are difficult.

Don't be surprised if you vomit. More times than not, my son did when things got going on the toilet. The cleansing is a bit thorough. I think it causes stomach spasms.

With my son's first colonoscopy, they used twilight sleep. It didn't really work and he screamed through the entire thing. Now they use propofol. If you have ever had an issue with sedation, insist that they use something else.


This is a really great thread! Very thorough!!
 

movie zombie

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I am currently in the week before prep stage with my appointment scheduled for December 22.
over the counter laxatives I do not believe do the job of getting the colon cleansed.
part of my food avoidance this week is seeds, nuts, brown rice, and veggies are to be peeled.
I would assume the same for apples.
I have stopped all my herbs and vitamins.
i'm waiting to hear back from the dr re stopping Benefiber which I take on a daily basis.
eta: dr says ok to take but to stop the day before the procedure.
I believe raw veggies are a no-no.

your dr should be providing you with written instructions.
my instructions said not to follow those that came with the MoviPrep that was prescribed but to follow those provided by the dr.

this is a link to my medical provider and I think will work for anyone: http://www.pamf.org/prep/
2nd eta: follow your own dr's orders!
 

azstonie

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Where I worked Crystal Light drinks (clear ones) were recommended by the docs and they also recommended to use the Crystal Light to mix with the powdered colon prep, makes it a little more palatable. Also, once you've mixed the prep put it in the fridge, also makes it slightly less gross.

Use your judgement on how much liquid prep to drink as you near the end of your prep procedure. One of my coworkers (a normal-sized woman) at the clinic drank ALL her prep (because that is what the instructions said to do) and only on the last bit got really sick and miserable. When she arrived at the endoscopy suite, the doc told her that for someone of her size, she did not need to have consumed the last portion.
 

movie zombie

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I was also advised to add Crystal Light to the prep to make it somewhat tolerable....and Lemon was the recommended flavor.
 

VRBeauty

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Those flavor powders and drops are a prep day godsend! My favorite was Crystal Light liquid Tropical Coconut - sort of a pina colada flavor - LOL. It's orange, but apparently not enough so to cause a problem with the colonoscopy!

Zoe - I didn't realize what you were asking about was your doctor's prescription! :oops: Personally, I have trouble drinking much gatorade... so I'd be calling the doctor to discuss alternatives, or at least ask whether I could substitute water or other clear liquids for some of the gatorade.
 
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