R&C: A Tale of Two Bowel Preps

So last week I had the distinct, uh, pleasure of having my first colonoscopy.  To answer your questions:

  1. Yes, I’m too young for that
  2. I had to get one because of family risk factors, that I’m irrationally annoyed about.
  3. Yes, talking about it could be considered TMI

With that out of the way, I’m at least going to talk about #3 there.  Colonoscopies are weird and uncomfortable to talk about yes, but colorectal cancer is the 2nd deadliest cancer (behind only lung cancer) in the US, and it just doesn’t have to be like that.  It’s pretty treatable if caught early, and removing polyps can prevent it all together.  Despite this, many people still skip or delay their colonoscopies because they’re embarrassed.  More info here.  By talking about it, I’m hoping to do my small part in normalizing the experience.  If we all talk/laugh/whatever about it, maybe more people will go.

Anyway, if you go to get a colonoscopy, nearly everyone will tell you the preparation is the worst part.  You have to do a clear liquids diet for a day, and drink whole bunch of stuff to clean you out.  The subject of my paper this week is what that drink actually is, and what the alternatives are.

When I told people I was going, a lot of people warned me about the drink.  When I got my instructions, I was interested to see that there was not special drink.  I was told to by an over the counter bottle of MiraLax and some Gatorade, mix them together, and to drink that.  Several people were rather surprised that this was an option, so I decided to look in to it.  I found this paper: Randomised clinical trial: MiraLAX vs. Golytely – a controlled study of efficacy and patient tolerability in bowel preparation for colonoscopy by B. K. Enestvedt,M. B. Fennerty and G. M. Eisen.  Success!  This paper covered exactly what the two drinks were, and why you might pick one over the other.

Interesting side note:  The third drink mentioned (currently advised against by the FDA) causes a severe reaction in some people.  My boss was apparently one of those people, and her first colonoscopy was the closest she ever felt to death.  That was a really fun story to hear 3 days before going for mine.

Anyway, here’s the paper30Jun15

Interesting huh?  Before I found this paper, I had actually asked the nurses at my center why they used the Gatorade mix instead of the Golytely.  They told me that at least at their center, they had been struggling with patient complaints about the Golytely and lower compliance, and effect not really seen in this study. That matched my anecdotal experience of friends and family wondering why they hadn’t been told their was an alternative. My center also uses a slightly different prep scheme than was used in this study, which the study author suggest could make it more effective (for this study the Golytely prep and the Miralax prep were identical in terms of timing).

Regardless, my prep appeared to have worked, so that’s nice.  I’ll be back in 3 years or so, she said ruefully.