# Good news for colonoscopy prep! **URL:** \ **Category:** In My Humble Opinion\ **Created:** [July 9, 2013, 11:23pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087 "2013-07-09T23:23:40Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [July 9, 2013, 11:23pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/1 "2013-07-09T23:23:40Z")
Not a sentence I thought I’d ever write ;). The FDA finally approved a sodium picosulfate-based prep for use in the US - people in Canada and Europe have been using it for a number of years. I saw the doc today (followup for the northern end, discussion of the next southern exploration in a few months…). I mentioned the problems I’d had with OsmoPrep (sodium phosphate pills… for me, they were “the gift that keeps on giving”), and my problems with textures and large quantities of torture, and he mentioned that picosulfate had been approved finally. He’s used it with a few patients and so far it seems like it’s working well enough - hasn’t used it for enough of them yet to form a long-term opinion. Also it may be hard to get for a bit. But he _did_ say he tasted it and it wasn’t bad. [Linkitude](http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312315.htm) Another alternative we talked about is SUPrep (which is pure sodium sulfate in a very bad tasting - but low volume - liquid). Doc said that some people found that alternating it with sucking on a menthol lozenge helped with the bad test of that. He also noted that nausea was pretty common with it. He offered me Zofran (antinausea med) if I wanted to go that route. I decided not to go with that since the picosulfate version has become available. He really didn’t like my suggestion of the Gatorade+miralax thing even though I assured him I’d done the math on the electrolytes (which are NOT difficult to make up). He’s a bit paranoid, I guess. ---
**Author:** ![CalMeacham](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/calmeacham/32/35_2.png) [@CalMeacham](https://boards.straightdope.com/u/CalMeacham)\ **Post date:** [July 10, 2013, 1:39am UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/2 "2013-07-10T01:39:44Z")
Ah, yes, I recall the Good Old Days at Colonoscopy Prep. The Homecoming Dance TP’ing the Headmaster’s House The Crappie Derby Our rivaly with Gall Bladder High Our Mascot, Rolly the Dung Beetle It brings back a tear to the eye. Let’s all drink a sodium picosulfate toast (or, if you’re Old School, a sodium citrate toast) to Ol’ Colonoscopy Prep. ---
**Author:** ![Mithras](https://avatars.discourse-cdn.com/v4/letter/m/f04885/32.png) [@Mithras](https://boards.straightdope.com/u/Mithras)\ **Post date:** [July 10, 2013, 2:38pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/3 "2013-07-10T14:38:32Z")
Barring advances, I’ll probably need to be cleaned out every five or ten years for (hopefully) the next five decades. So it’s good to hear that the next time I might be able to use something less foul. I used Suprep for the last one. No nausea, but it was by far the worst thing I’ve ever consumed. I wasn’t half way through chugging the first dose when I began to dread taking the second. ---
**Author:** ![bup](https://avatars.discourse-cdn.com/v4/letter/b/6bbea6/32.png) [@bup](https://boards.straightdope.com/u/bup)\ **Post date:** [July 10, 2013, 3:01pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/4 "2013-07-10T15:01:38Z")
How serendipitous. At my physical a few weeks ago I found out I’m getting one of my 50th birthday presents a year and change early. It’s scheduled next week. Maybe I’ll call and see if I can switch the meds I take the day before. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [July 10, 2013, 3:33pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/5 "2013-07-10T15:33:03Z")
> [@Mithras](#): > > Barring advances, I’ll probably need to be cleaned out every five or ten years for (hopefully) the next five decades. So it’s good to hear that the next time I might be able to use something less foul. > > I used Suprep for the last one. No nausea, but it was by far the worst thing I’ve ever consumed. I wasn’t half way through chugging the first dose when I began to dread taking the second. I’ll be doing it every year for a bit - my screening one at age 50 turned up some “wouldn’t have wanted you to go another 5 years with that” polyps, the next one a year or so later turned up MORE of those (and he didn’t get the best margins on one)… ditto the one 4 months later (well, he got good margins that time), and the one 6 months after THAT. At least the 4th one looked enough better that I got to go a whole year :p. SUPrep is funny: it’s sodium sulfate (and potassium sulfate and magnesium sulfate). Sodium sulfate is the stuff they have in GoLytely but took out to make NuLytely because it’s one of the things that makes it taste especially bad. Yeah, less of it, but all the badness concentrated so you can really savor the flavor :p. If anyone _does_ try SUPrep, the suggestion for a menthol lozenge is worth trying - the doc said something about studies supporting that. You just can’t have the lozenge within a couple of hours of the procedure which is fine, you should have swallowed all the hemlock well before all that. > [@CalMeacham](#): > > Ah, yes, I recall the Good Old Days at Colonoscopy Prep. > > The Homecoming Dance > TP’ing the Headmaster’s House > The Crappie Derby > Our rivaly with Gall Bladder High > Our Mascot, Rolly the Dung Beetle > > It brings back a tear to the eye. > Let’s all drink a sodium picosulfate toast (or, if you’re Old School, a sodium citrate toast) to Ol’ Colonoscopy Prep. 😃 ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [July 10, 2013, 3:41pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/6 "2013-07-10T15:41:07Z")
Oh yeah, I spotted [this article (pdf)](http://www.asge.org/uploadedFiles/Publications_and_Products/Practice_Guidelines/colonoscopy%20prep.pdf) which has this interesting observation: > [@](#): > > The nonabsorbable carbohydrates used for colon preparations, when fermented by colonic bacteria, can lead toproduction of the combustible gases hydrogen and methane. This can lead to colonic-gas explosion during electrocautery use. > This complication was previously described with mannitol preparations and also more recently with sorbitol. > > In a 2007 review, a total of 10 cases of colonic-gas explosion during colonoscopy were reported… > In addition to ingestion of nonabsorbable carbohydrates,incomplete colon preparation, as is typically prescribed for flexible sigmoidoscopy or inadequate preparation for colonoscopy can lead to production of a combustible level of gases. :eek: So follow the instructions or you might become the first self-powered projectile to orbit the earth! ---
**Author:** ![muldoonthief](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/muldoonthief/32/3188_2.png) [@muldoonthief](https://boards.straightdope.com/u/muldoonthief)\ **Post date:** [July 10, 2013, 3:43pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/7 "2013-07-10T15:43:40Z")
Anyone else read the title and immediately think of [this](http://www.youtube.com/watch?v=6p8ZK_ujzdQ#t=12s) scene? ---
**Author:** ![Pai325](https://avatars.discourse-cdn.com/v4/letter/p/c68b51/32.png) [@Pai325](https://boards.straightdope.com/u/Pai325)\ **Post date:** [July 10, 2013, 5:46pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/8 "2013-07-10T17:46:14Z")
I have had four or five so far, and each time the prep has been different. So in four years, I get to try another prep! They have been easier each time though, so that’s good. Drinking those forty gallons of slime was the worst. Well, it see,ed like forty gallons. It was a never ending gallon of something. ---
**Author:** ![JerrySTL](https://avatars.discourse-cdn.com/v4/letter/j/e274bd/32.png) [@JerrySTL](https://boards.straightdope.com/u/JerrySTL)\ **Post date:** [July 10, 2013, 8:10pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/9 "2013-07-10T20:10:16Z")
I have a colonoscopy scheduled for the 22nd of this month. I’ve got the prep materials already, but don’t know exactly what they are. My wife had a colonoscopy a couple of months ago and she said that the prep wasn’t nearly as bad as in the past. Hopefully I have the new and improved stuff. ---
**Author:** ![ethelbert](https://avatars.discourse-cdn.com/v4/letter/e/958977/32.png) [@ethelbert](https://boards.straightdope.com/u/ethelbert)\ **Post date:** [July 11, 2013, 1:57pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/10 "2013-07-11T13:57:55Z")
I have had six colonoscopies and the last two have been Gatorade and Miralax plus four Dulcolax tablets. This was by far the best prep. ---
**Author:** ![Scubaqueen](https://avatars.discourse-cdn.com/v4/letter/s/c0e974/32.png) [@Scubaqueen](https://boards.straightdope.com/u/Scubaqueen)\ **Post date:** [July 11, 2013, 7:19pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/11 "2013-07-11T19:19:32Z")
Queen of Colonoscopies, here. 😃 How does the new stuff compare to the unadulterated taste of the previous mix - the GoLytely? I ask because since I have to have the damn things every year or two (thanks to Chronic Microscopic Collagenous Colitis ☹ ) I’ve been using ice-cold white grape juice to cut the GL. Will I still be able to do that? The juice makes all the diff in the world. Nausea hasn’t been an issue since. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [July 11, 2013, 7:48pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/12 "2013-07-11T19:48:38Z")
> [@Mama\_Zappa](#): > > Oh yeah, I spotted [this article (pdf)](http://www.asge.org/uploadedFiles/Publications_and_Products/Practice_Guidelines/colonoscopy%20prep.pdf) which has this interesting observation: > > :eek: > So follow the instructions or you might become the first self-powered projectile to orbit the earth! You know you’re in trouble when inflatable slides pop out of your anus and the polyps escape on them. The only important thing for me is the volume. I can stand small amounts of anything, but after a few I don’t even want to see Gatorade any more. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [July 11, 2013, 8:26pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/13 "2013-07-11T20:26:40Z")
> [@Scubaqueen](#): > > Queen of Colonoscopies, here. 😃 > > How does the new stuff compare to the unadulterated taste of the previous mix - the GoLytely? > > I ask because since I have to have the damn things every year or two (thanks to Chronic Microscopic Collagenous Colitis ☹ ) I’ve been using ice-cold white grape juice to cut the GL. > > Will I still be able to do that? The juice makes all the diff in the world. Nausea hasn’t been an issue since. I told the doctor that GoLytely - from everything I’ve ever heard - is just deliberate torture given the number of better alternatives including lower-volume PEG preps (also including PEG-based ones without the sodium sulfate). I haven’t tried it myself. I flat out refused it. My understanding is that with pretty much any of the non-PEG versions, you can use any liquids you like. Not a bad idea to use something with some sodium and potassium (Gatorade or its much-better-tasting spinoffs, broth, etc.). So yes, you’d be able to use grape juice, ginger ale, or whatever. I _have_ used OsmoPrep (sodium phosphate) tablets. Aside from being gi-fucking-normous and a bit salty tasting, and of course having to take them with 8 ounces of water every 15ish minutes, they’re reasonably tolerable. The salty taste is quickly masked by whatever you wash it down with. I was told Gatorade (but have since found alternatives, including using juice and just adding a bit of salt/salt substitute). For me the only real problem with the OsmoPrep is that, well, it “keeps on giving”. The last 2 times, it was still “working” 6 hours after the evening dose :(. And the next morning… well, let’s just say the people who emptied the trashcan in the patient waiting area had an unpleasant surprise, and I was glad I brought spare undies. And even after the procedure, the first warm food I ate brought on a repeat performance :eek::mad:. Aside from that (and of course the whole “possible kidney damage” thing), OsmoPrep is fine. With my first procedure, I was on liquids-only for _two_ days before, and had a dose of DulcoLax - possibly this was why I didn’t have the same issues that time. I’ll report back on the taste of the new stuff once I’ve had my procedure. Like I said, the doc tried it and said it wasn’t bad, and of course it’s a small volume (5 ounces). The instructions say to mix with water but they also say drink plenty of other liquids, so I can’t imagine it’d be a problem to mix it with something else. Annoyingly, they say no alcohol 😉 ---
**Author:** ![Ann\_Hedonia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ann_hedonia/32/319_2.png) [@Ann\_Hedonia](https://boards.straightdope.com/u/Ann_Hedonia)\ **Post date:** [July 11, 2013, 8:33pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/14 "2013-07-11T20:33:22Z")
> [@Mama\_Zappa](#): > > He really didn’t like my suggestion of the Gatorade+miralax thing even though I assured him I’d done the math on the electrolytes (which are NOT difficult to make up). He’s a bit paranoid, I guess. So, what’s the problem with the Gatorade + Miralax prep? I’ve been given that for both my colonoscopies and I was under the impression it was standard and the colonoscopy nurses said it’s the best prep routine ever. Only tip was the first time I was told any flavor of Gatorade except red or orange, so I picked lemonade (not lemon lime, lemonade). It was really acidic which gave me some stomach issues, I used blue Gatorade the second time and that was much better. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [July 11, 2013, 9:34pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/15 "2013-07-11T21:34:16Z")
> [@Ann\_Hedonia](#): > > So, what’s the problem with the Gatorade + Miralax prep? I’ve been given that for both my colonoscopies and I was under the impression it was standard and the colonoscopy nurses said it’s the best prep routine ever. > > Only tip was the first time I was told any flavor of Gatorade except red or orange, so I picked lemonade (not lemon lime, lemonade). It was really acidic which gave me some stomach issues, I used blue Gatorade the second time and that was much better. He’s really paranoid about electrolytes. In some ways he’s overcautious (e.g. electrolytes, his Gatorade restrictions also rule out purple or blue!!), in others not so much (said that the NaP prep had never caused problems for his patients). I could probably insist on the Gatorade variant at my own risk, or lie about which one I’d done. Interestingly, it doesn’t seem like the picosulfate preps include electrolytes. I didn’t bother to point out that little inconsistency ;). ---
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [July 12, 2013, 12:54am UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/16 "2013-07-12T00:54:05Z")
I have had horrible horrible experiences with all 3 forms of prep I have used that my doctor says I can liquid fast and enema. Better to simply suffer shitty nutrition and blood glucose than spend a week shitting my brains out and getting hospitalized. I will _not_ be trying the new prep! ---
**Author:** ![Scubaqueen](https://avatars.discourse-cdn.com/v4/letter/s/c0e974/32.png) [@Scubaqueen](https://boards.straightdope.com/u/Scubaqueen)\ **Post date:** [July 12, 2013, 3:28pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/17 "2013-07-12T15:28:54Z")
> [@Mama\_Zappa](#): > > Aside from that (and of course the whole “possible kidney damage” thing), OsmoPrep is fine. \>snip!\< whoa, whoa, whoa… :eek::eek::eek: hold the phone, **Mama**. KIDNEY DAMAGE THING??? Never heard of that before. Thanks to years of anti-inflammatories, I now have to watch my kidneys in order to avoid trouble in the form of elevated creatinine, which can truly eff up my kidneys for the rest of my life. Is OsmoPrep well known for this? ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [July 12, 2013, 7:34pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/18 "2013-07-12T19:34:13Z")
> [@Scubaqueen](#): > > whoa, whoa, whoa… :eek::eek::eek: hold the phone, **Mama**. KIDNEY DAMAGE THING??? > > Never heard of that before. Thanks to years of anti-inflammatories, I now have to watch my kidneys in order to avoid trouble in the form of elevated creatinine, which can truly eff up my kidneys for the rest of my life. Is OsmoPrep well known for this? If your kidneys are at particular risk, you definitely would want to discuss the pros and cons of a phosphate-based prep. [Phosphate nephropathy](http://en.wikipedia.org/wiki/Phosphate_nephropathy) is a known possible side effect of sodium phosphate - serious enough to warrant a black-box warning from the FDA. I believe the liquid version (Fleet’s Phospho-soda) may have even been discontinued in the US. I have no idea whether your own health issues put you at greater risk of phosphate nephropathy. Now, my doctor isn’t too worried about it. Despite my having a number of health issues, they’re all well controlled, I’m in pretty good shape for being in such bad shape :p, I have no known kidney issues, no concerns over inability to follow instructions and hydrate well - so he was fine with me trying the OsmoPrep. If my husband were to ask for it, however, I’d put my foot down - his kidney levels are NOT the best and he has to be especially careful not to do something that might damage them. Oh - and to clarify further: I have not heard of any kidney risks with any of the other variants (PEG-based, SuPrep, etc.). Each has its own set of concerns, but NaP is the one that’s notorious for fucking with your kidneys. ---
**Author:** ![Noodles\_Fellicini](https://avatars.discourse-cdn.com/v4/letter/n/e36b37/32.png) [@Noodles\_Fellicini](https://boards.straightdope.com/u/Noodles_Fellicini)\ **Post date:** [July 14, 2013, 11:53pm UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/19 "2013-07-14T23:53:39Z")
I found the SUPREP to be a breeze. I started a low-residue diet a couple of days early and followed the liquids-only requirements to the letter. Did 3/4ths of the first dose along with the entire container of wold water, and only 1/2 of the 2nd dose with the entire container of cold water, along with a quart of Powerade, some Vitamin Water, and some chicken broth. I mixed it with cold water and didn’t find it to be nasty at all, just a faint grapey taste. Both doses were the afternoon/night before an early morning appointment, and I was finished with prep and sound asleep by midnight. Was given the “perfect prep” review by the gastroenterologist, which he apparently didn’t give very often. I can honestly say I was not nauseous or overly bloated/crampy, even though I am usually sensitive to everything. I was also not miserable because I laid in a supply of lotion tissue, Tucks (which I didn’t need) and Vaseline used to pre-treat the exit area with a nice soothing protective layer. After hearing all the horror stories and dreading the prep procedure, I can honestly say I don’t fear the next one even a little bit as long as it is SUPREP again. ---
**Author:** ![rsat3acr](https://avatars.discourse-cdn.com/v4/letter/r/a3d4f5/32.png) [@rsat3acr](https://boards.straightdope.com/u/rsat3acr)\ **Post date:** [July 15, 2013, 12:08am UTC](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087/20 "2013-07-15T00:08:39Z")
[quote=“Mama\_Zappa, post:18, topic:663087”] If your kidneys are at particular risk, you definitely would want to discuss the pros and cons of a phosphate-based prep. [Phosphate nephropathy](http://en.wikipedia.org/wiki/Phosphate_nephropathy) is a known possible side effect of sodium phosphate - serious enough to warrant a black-box warning from the FDA. I believe the liquid version (Fleet’s Phospho-soda) may have even been discontinued in the US. I have no idea whether your own health issues put you at greater risk of phosphate nephropathy. Yes Fleet Phospo-soda was taken off the market about four years ago IIRC. Used it for several colonoscopys and liked it because the volumn was less then the others. Oh well half a gallon to drink next month. [Next page](https://boards.straightdope.com/t/good-news-for-colonoscopy-prep/663087.md?page=2)