Colonoscopy prep can be challenging

By Joe Graedon, M.S., and Teresa Graedon, Ph.D.

Q. My question is about the prep for colonoscopy. My husband has had two; I have had one. It seemed to me that, although the prep was unpleasant for both of us, it was worse for me. Consequently, when it came time for my second colonoscopy, I opted for Cologuard instead, with my doctor’s agreement.

I weigh 120 pounds, and my husband weighs 210 pounds. Are any allowances made for such size differences when the prep solution is prescribed? I doubt it; it seemed like the product came in one standard size for each of us. Should allowances be made?

A. Periodic colonoscopies are an excellent way to detect colon cancer or, preferably, polyps even before they go rogue and turn into cancer. Since the polyps are removed during the procedure, they should not have a chance to cause further trouble.

You are correct that the bowel prep prescribed before a colonoscopy usually comes in a standard amount of powdered polyethylene glycol (PEG, an osmotic laxative), often with electrolytes, to be dissolved in 4 liters of water.

The traditional instructions do allow for some personalization of dose. Patients are told to drink a cup every 10 minutes until the watery stool is completely clear. If you reached that point sooner than your husband, you could stop earlier.

Newer recommendations call for a “split-dose” approach. People are told to drink half the solution in 10- to 15-minute intervals starting in the late afternoon or early evening before the procedure. The second half is consumed in increments about four to six hours before the colonoscopy. Don’t give up on colon cancer screening; it can be a lifesaver.

Q. Some years ago, my aunt was doing poorly, so I took my mother to see her. Because I’m a doctor, I was asked to review the meds. She had six over-the-counter and 25 prescribed drugs with various dangerous or negating interactions. She was barely able to get out of bed.

Her primary care doc knew all the meds were a problem but would not change them because specialists had prescribed them. When my aunt woke up and joined the conversation, I told her she needed less than a handful of prescriptions. That didn’t bother her, as she didn’t think they were doing her any good.

The medication taper was tricky and required ER visits, but my aunt got off most of the benzos, narcotics and sleeping pills, as well as most of the other multispecialty drug mess. She regained her alertness and lived well for over five years. Drug interactions are underappreciated, especially as a problem for older people.

A. We couldn’t have said this better! It’s far too easy for older people to accumulate drug prescriptions that may not work well together. Someone should monitor for medication incompatibility and lobby for deprescribing when appropriate.

To make that process easier, we offer our top 11 tips for preventing dangerous interactions in our book “Top Screwups.” You may find it in your local library or in the books section of the store at www.PeoplesPharmacy.com. Although drug combinations are especially dangerous, interactions with foods, herbs or other dietary supplements can also pose problems.

One new medicine that can conflict with many other drugs is Paxlovid (ritonavir and nirmatrelvir). This pill is prescribed to help people recover from COVID-19. It interacts with dozens of medications, including atorvastatin, buspirone, clonidine, estrogen, prednisone and sildenafil.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, Fla., 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”