Golytely prep didn't work

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I am an RN and new to all nurses.com. I had a colonoscopy scheduled for 4 days ago. Two days before the procedure, I was on clears starting at noon and drank a jar of Mag Citrate. Then I was to do my Golytely over that day and the next--1/2 jug each day. (Sorry if this is too graphic--feel free to skip it--you've been warned!)

The first day I had dark brown diarrhea which turned into dark brown applesauce textured stool with liquid and lots of particulate matter.

Second day (still on clears, of course), it pretty much stayed the same all day, but with everything getting lighter brown and the particulate matter decreasing. Stayed up til 1:30a, hoping more would come out, or come out clearer. Nope.

Up at 6am. Still some applesauce consistency (but considerably less) with now very light tan liquid. Called GI Center to see if an enema, or bisacodyl tabs or Miralax would help as a last ditch effort. (My procedure was scheduled for 11a.) Told by the charge RN "not to worry, and if you need an enema, we'll do it when you get here". Asked if I should call the doc, and she said "no, when this happens, we deal with it as it comes".

Feeling pretty yucky by 11a. Lots of rumbling/gurgling in the upper left side of the colon, as if something wanted to get througgh, but couldn't.

Had had to reschedule procedure several times because I could not find a ride (people work, after all!), so having scheduled two people to tag-team staying in the waiting room and taking me home (which the staff almost didn't allow!), I really wanted this to go without a hitch.

Even though I was scheduled to arrive at 11a, after I had done initial clerical paperwork (nothing even about medical/surgical history yet), I was told to wait in the waiting room until about noon or so, and that my actual procedure was scheduled for 12:30p! Grrrrrr (especially since I had to have my driver(s) with me from my appointment time on...)

Anyway, I told the incoming clerk, the MA, and an initial RN re: my prep and results. All said "Don't worry--we'll just wait til the doctor gets here". I asked if they could CALL the doc and explain re: my prep, so that I could do enema or whatever before she'd arrive probably chomping at the bit to get started. The RN said it wasn't necessary, then told me the doc would probably cancel the procedure anyway!

She wanted to start my IV and get me totally ready though, since the docs like the patients to be ready to go once they arrive. I refused the IV at this point (I'm a hard stick, but that's beside the point...). The charge nurse then came to see me and re-iterate how important it was that I was "ready", even if the doc ultimately decided to cancel the procedure. Still refused, much to her dismay. I'm sure by then I was labelled as a "difficult" patient, as I fell outside of the norm of their fast-paced, efficient GI Center.

Anyway, the doc got there and said we'd have to cancel and start from scratch another day OR, if I could get a ride for the next day, could just complete the prep that night and have the procedure the next day. No driver available, so I had one day off of clears, and now I'm on my second day of clears and half-way through my second jug of Golytely and, while lighter brown than yesterday, I still have some applesauce consistency stool coming out! And, this morning I've developed a rectal hemorrhoid and also what feels like a lady partsl hemorrhoid which is bleeding!

The only thing I can figure that I've done differently is that I've taken the Golytely throughout the day (as instructed) instead of the usual "Start at 5pm..." prep. Would that make a difference?

BTW, I am having this procedure due to chronic (but worsening) constipation, family hx of polyps and cancer, and recent KUB which showed my entire bowel to be FOS(!). Had had distention and gas pain and stool every week and a half or so with straining. BTW, I drink 3 liters of plain H20 daily, and am on a high-fiber (vegan, actually) diet, but don't exercise much.

I guess I want to know if anyone has seen this happen before?

Any suggestions/ideas/advice? Would like to hear from you as soon as possible!

Thanks (and sorry for being so long-winded)

--Trish

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

Only advice i can suggest is asking the very questions to your doctor.

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Specializes in Med-Surg.

Given that your entire colon was FOS, it's not surprising it has taken a couple of days to clear. Don't be too horribly alarmed. Remember "clear" means watery, not necessiarly the color of water.

Many patients aren't clear after one prep, or need additional enemas once they arrive.

Good luck.

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Specializes in LTC,Hospice/palliative care,acute care.
I am having this procedure due to chronic (but worsening) constipation, family hx of polyps and cancer, and recent KUB which showed my entire bowel to be FOS(!). Had had distention and gas pain and stool every week and a half or so with straining. BTW, I drink 3 liters of plain H20 daily, and am on a high-fiber (vegan, actually) diet, but don't exercise much.

I guess I want to know if anyone has seen this happen before?

Any suggestions/ideas/advice? Would like to hear from you as soon as possible!

Thanks (and sorry for being so long-winded)

--Trish

as Tweety says you may need a double prep...As for your diet-all of that fiber can cause gas and distension and without some fat can be binding (you may need to add some olive or other vegetable oil) Excercise (walking) will help with motility....With your family history you don't want to fool around-good for you for looking into the problem....Good luck
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Well this is probably a little late. I'm sorry you weren't listened to when you tried to tell them your prep wasn't adequate. We usually tell people to call their doc if they call & say the prep isn't working so if the doc want's to have them take additional prep they can. Around here I don't see many golytely preps anymore. You might ask about another prep next time. As for getting a ride, does the center not offer transportation? Every center I've worked for offers transportation for people who can't get a ride, where I'm working now it's $15 round trip. I don't blame you for refusing the IV. If we have any question regarding cx a procedure we don't even make the pt change until we've checked with the doc. We will skip the person & keep admitting other patients for that doctor so there will be someone else will be ready for them until things are clarified. We don't like to stick people needlessly if we can help it. Hope your 2nd try worked out better.

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Per the Terms of Service of this Bulletin Board, we are unable to provide medical advice.

Pleae follow up any of your concerns with your medical care provider.

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