Handling the Dreaded Colonoscopy

Author: Mark Parkinson BsPharm:  President  AFC-CE

Credit Hours 1 - Approximate time required: 60 min.

Educational Goal

Tell Adult Foster Care Providers what a colonoscopy is and how to prepare for the procedure.

Educational Objectives

  • Tell what a colonoscopy is, why we need one, and who performs it.
  • Instruct how to properly prepare for a colonoscopy.
  • Discuss issues specific to AFC providers

Procedure:

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Disclaimer

The information presented in this activity is not meant to serve as a guideline for patient management. All procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this article should not be used by care providers without evaluation of their patients’ Doctor. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication. Nutritional products discussed are not intended for the diagnosis, treatment, cure, or prevention of any disease.

 

 

Handling the Dreaded Colonoscopy

Talking about poop is unpleasant so forgive me if I take a less-than-scientific tack on the subject. I hope you enjoy the jokes.

 

Just about everyone has heard about the unpleasantness doctors call a Colonoscopy.  You know, that procedure where you take enough laxative that you could pass a 54 Chevy truck through your colon, and then the Doc shoves a camera up your butt for a look around inside. Gross, who would want that? Well, no one. You even might be tempted to skip this CE because it is an unpleasant subject. I wouldn’t if I were you. Unfortunately, you are going to have to face it sooner or later. Either as a patient or as a caregiver to a patient who must have one. So you might as well be prepared for it by getting in the know now.

Why do I have to get one

A Colonoscopy is the best way for the doctor to look for disease-related changes in your colon. Such as swollen irritated tissues, ulcerations, or polyps. What’s a polyp?  A polyp is a small clump of tissue that sticks out from the colon lining. They look like a wort or a mushroom. It is caused by an abnormal growth of cells. Most people have one or more polyps hanging around in their guts. Either you’re born with them, or they grow later on. The older you get the greater the chance that you have a bunch of them growing in your intestines.

For the most part, you can’t feel a polyp growing and you can’t see them on an X-ray. That is why a doctor has got to go in and visually look for them.  Why does the Doc have to do that? Because they can turn cancerous, that’s why. Then the cancerous polyp can spread into full-blown colorectal cancer, the third leading cause of cancer-related deaths in Americans. I bet I got your attention now, don’t I?

Health authorities recommend that everyone gets a cancer screening colonoscopy at the age of 50. Then continue to get them every 10 years until you’re 75 years of age. Why ten years? Because studies show that it takes about ten years for a polyp to turn cancerous and start causing problems. If cancer is suspected or if you’re at greater risk (smoker, diabetes, Crohn’s disease, Irritable Bowel Syndrome, family history) then they recommend having one every 7 years. If the cancer is caught early enough there’s a good chance of getting it taken care of. (90% cure rate).

One of the good things about getting a colonoscopy is, it can also be part of the cure. While the doctor is having his little picture safari through your colon, his camera (called a colonoscope) comes equipped with some special grabbin’ gadgets. He can lasso the polyp with an electrical wire and burn it clean off. He then can grab the thing and drag it out. After that, they’ll ship it off to a lab someplace and get it checked for cancer. It’s like nippin’ the cancer in the bud.

Getting the job done

Oh by the way, the doctor who specializes in colonoscopies is called a gastroenterologist. What a mouthful. You can find them in (you guessed it) the Gastroenterology department.  If you ever find yourself wandering around the hospital trying to find where to get your colonoscopy, that’s where you’ll head to. Just imagine all the fun you’re going to have when you find the place.

When you arrive at the front desk the fun will start when the receptionist asks you about your insurance and then hands you some paperwork to fill out. There are always forms to fill out, aren’t there? You best have the insurance card handy. If you are shepherding one of your residents through, it would be easier for you if you bring their files along. After that knockabout bit of fun is over you get to wait in their luxurious lobby in their oh-so-comfortable chairs. There is always uncomfortable waiting, isn’t there? Best be prepared with some amusements to pass the time away. Unless you enjoy thumbing through out-of-date magazines that talk about subjects you have no interest in. You can always just stare at the walls and try to make time fly by continually looking at your watch, that’s always amusing.

The fun really begins when the nurse calls out your name and escorts you into the examination room. She is going to tell you to take off all your clothes. Don’t worry, you’re not going to run around buck-naked. They’ll hand you one of those funny backward rob that always makes you feel like your butt is hanging out. This time you’ll want it to hang out because that’s where all the action starts. But first (I think I am saying butt too much) the nurse is going to stick a needle in your arm and give you the good drugs. The kind that makes you loopy or just plain knocks you out. So don’t worry about discomfort or embarrassment. You won’t feel a thing, once the meds kick in. The procedure takes about 30-60 minutes. Depends on how many polyps the doctor wants to nip off. But you won’t care, you’re going to be in la la land with doctor feel-good drug. Naturally, you are going to be kind of loopy for a long time. You had better have someone with you to help you get dressed and drive you home afterward. Before you go, the doctor will pull you aside and tell you what he saw and did on his journey through colon land. He might even have to tell you that he couldn’t see a thing because you didn’t do the bowel prep right and left too much poop behind in your behind. Oh what a joy that message is to receive. You’ll have to do the whole thing over again and pay for the procedure twice. Don’t yell at the doctor, it’s your fault after all. You didn’t do the prep right.

 

 

 

Bowel Prep (Getting it done right the first time)

Okay, this is where I get serious. For Adult Foster Care providers this is the important stuff. The Doctor is going to give you some written instructions. For medical record purposes, treat this like a prescription. I would place them in the patient’s file.  Just to be complete, handwrite any medications into the PRN MARS.  Don’t forget to add comments about the effect of the medication. Most likely the instructions will tell you to buy the laxatives over the counter. They are pretty cheap but if there is no money available then get a separate prescription to take to the pharmacy. Most insurances will cover it but there is no guarantee. If there are problems, ask the pharmacy tech to call the insurance company and ask for an override.

Taking other medications during this prep time is going to be kind of tricky. Get the Gastroenterologist or the regular doctor to review the patient’s medication and give you detailed instructions on how to proceed- in writing. If they balk at that, remind them that you are a government-regulated care facility without the authority to make any changes to med regimes- without written instructions from the doctor. That’ll get their attention.  Remember to note in the MARS, the When and Why you skipped a medication.  I recommend the letter “C” in the MARS and “C= skipped med due to colonoscopy” in the comment section. Doing all of the above will make the yearly county inspection go much smoother.

Each Doctor is going to have their favorite bowel prep medications and instructions. Don’t get too stressed about exact measurements or exact timing, getting close will be good enough. Err on the side of more liquid and laxative. If the instructions give you some nonsense about grams or capfuls of MiraLAX they mean mixing the entire contents of a small bottle into 2-quart size bottles of a Gatorade-like drink. If you have any questions, call the Gastroenterologist’s nurse.

The week before the procedure, eat a low-fiber diet. Avoid eating seeds, nuts, popcorn, or other high-fiber foods. Twenty-four hours before colonoscopy time, stop eating anything solid and avoid any red- or purple-colored liquids. If the resident gripe a lot about being hungry, Jello is considered a liquid for this procedure. Ice pops and bouillon broth also work, just no red or purples. Drink plenty of liquids. Carbonated pop is okay, coffee and tea too. But NO milk, cream, or yogurt. No alcohol, so you can’t get drunk. Even if you want to be.

Later in the afternoon before procedure day, take the laxative pills and Half the MiraLAX mixture. Drink the rest of the mixture the morning of. See the instructions for precise times. You are going to be instructed to drink more liquids above and beyond the MiraLAX mix. The goal of all this prep work is to poop out semi-clear, lightly colored liquids. Tell the patient not to flush the toilet because you are going to check it. Gross yes, but it’s better than having to do the whole thing over. Don’t let the patient wander away from a toilet or you’ll be doing some extra poop cleanup. On the day of the colonoscopy do not eat or drink anything in the morning. Take medications with small sips of water. The goal is to not have anything in your stomach that you will throw up due to sedation-caused nausea.

 

Prep Times example

 

 

 

 

 

 

 

 

 

 

 

Source Colonoscopy - Prep and Procedure Overview | Penn Medicine

 

 

I got some time left in this lesson, so I am going to include two YouTube videos for the visual learners in the crowd. Fair warning, there might be some test questions.

Video 1.

 

Video 2.

In the video, the doctor talks about tips concerning a bowel preparation called Golytely. (What a pleasant name for an awful result). It’s basically the same as the MiraLAX mixture mentioned above.

 

Conclusion

Like this subject, I find myself all pooped out, (which is the goal, right). I can’t think of anything else useful to write about- except to say, remember the record-keeping requirements of the job and- as always,

Good Luck in your Caregiving Efforts.

Mark Parkinson BsPharm

References:

  1. Clyde M. Stauffer; Christopher Pfeifer. Colonoscopy. StatPearls, National Library of Medicine. July 24, 2023. https://www.ncbi.nlm.nih.gov/books/NBK559274/
  2. Colonoscopy. MayoClinic.org, Feb. 28, 2024. https://www.mayoclinic.org/tests-procedures/colonoscopy/about/pac-20393569
  3. Matt McMillen. Colonoscopy. WebMD.com, May 17, 2024. https://www.webmd.com/colorectal-cancer/colonoscopy-what-you-need-to-know
  4. What happens during and after a colonoscopy? You and Colonoscopy Mechanism in Medicine Inc. Dec 22, 2016. https://www.youtube.com/watch?v=mh90RPA-C10
  5. Why Your Doctor Wants You to Get a Colonoscopy. WebMD.com, May 23, 2023.https://www.webmd.com/colorectal-cancer/why-get-a-colonoscopy
  6. Colonoscopy Prep. ClevlandClinic.org. 03/24/2022. https://my.clevelandclinic.org/health/treatments/22657-colonoscopy-bowel-preparation
  7. Colorectal Polyps, Causes, Signs and Symptoms, Diagnosis and Treatment. Medical Centric. Mar 9, 2020. https://www.youtube.com/watch?v=gAE5NZa6V-c

 

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