Q. My question is about colonoscopy preparation. My husband has had two; I’ve had one. It seemed to me that while the preparation was unpleasant for both of us, it was worse for me. So when it came time for my second colonoscopy, I chose Cologuard instead, with my doctor’s approval.
I weigh 120 pounds and my husband weighs 210 pounds. Are such size differences taken into account when prep solution is prescribed? I doubt it; it seemed like the product came in one standard size for each of us. Should supplements be granted?
A. Periodic colonoscopies are an excellent way to detect colon cancer or, preferably, polyps before they go rogue and become cancer. Since the polyps are removed during the procedure, they should not stand a chance of causing further problems.
You’re right that the bowel prep prescribed for a colonoscopy usually comes in a standard amount of polyethylene glycol (PEG, an osmotic laxative), often with electrolytes, to be dissolved in 4 liters of water.
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The traditional instructions allow some personalization of the dose. Patients are told to drink a cup every 10 minutes until the watery stool is completely clear. If you got to that point before your man did, you might quit sooner.
Newer recommendations call for a “split dose” approach. People are told to drink half of the solution at intervals of 10 to 15 minutes, 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 colon cancer screening; it can be a lifesaver.
Q. A few years ago my aunt was having a bad time, so I took my mother to her house. Since I am a doctor, I was asked to review the medications. She had six over-the-counter and 25 prescription drugs with various dangerous or negative interactions. She could barely get out of bed.
Her GP knew all the drugs were a problem, but didn’t want to 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. It didn’t bother her, because she didn’t think they were doing her any good.
Weaning off the medication was tricky and required visits to the emergency room, but my aunt was on most of the benzos, narcotics, and sleeping pills, as well as most of the other multi-specialty drug mess. She regained her alertness and lived well for over five years. Drug interactions are undervalued, 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 drugs that may not work well together. Someone should check for drug incompatibility and lobby for abolition if necessary.
To make that process easier, we offer our 11 best tips for avoiding dangerous interactions in our book “Top Screwups.” You may find it at your local library or in the book section of the store at www.PeoplesPharmacy.com. While drug combinations are particularly dangerous, interactions with foods, herbs, or other dietary supplements can also pose problems.
A new drug that may 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.
Questions for Joe and Teresa Graedon can be emailed through their website: www.PeoplesPharmacy.com.