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10 replies

Getting scoped years after j-pouch surgery: how much prep do YOU do?

SC Silo CityMember
I had my j-pouch surgery in 1997, and though I've had occasional bouts of pouchitis (including one recently), it's mainly been great, and life is normal and beautiful.

I saw my surgeon annually after the surgery, for him to run a scope into my pouch. This was done in his office, with no prep or sedation at all, and worked fine -- no problem.

Unfortunately, my surgeon has retired. Due to my recent bout of pouchitis I saw a new guy, a gastroenterologist. He prescribed both cipro and flagyl together for the pouchitis (which seemed to me to be overkill), and wanted to do a flex sig.

Here's what's bugging me: he's having me do the whole prep thing I'd do as if I had a colon -- I got a sheet telling me to avoid nuts and whatnot a week beforehand (which is ABSURD; if I eat corn, I'll be seeing corn in an hour...), I've got to drink that nasty Liquid Plumber stuff hour by hour the night beforehand, etc. And the procedure's being done in a hospital.

This is giving me the creeps -- I get the impression the guy hasn't seen many (or any) j-pouchers before. As a Colon-Free American, I'm really looking for a minimalist approach to the whole scoping thing, rather than the maximalist Super Bowl halftime show this guy seems to have in mind for me.

Am I being paranoid here? Was my surgeon lax in scoping me in his office prep- and sedation-free? I'm ready to jump ship on this guy, but I'd like to hear if I'm being a baby!

Many thanks!
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Jan DollarJan DollarModerator, RN, retired
Well, there are two possibilities. One is that your new GI just ordered the scope and did not think about tailoring it to you, so the staff just did the standard protocol. The other possibility is that this doctor actually does not know the difference.

Either way, you need to call back and clarify the prep and also tell him that you do not need to be in the hospital, with sedation, and all the increased costs associated with that. Some people prefer sedation, but it is not necessary, since it is not a time consuming or very invasive procedure. Plus, you are spot on with the prep. I think most docs do have us do some minimal enema prep to clear out the pouch before leaving the house, but not the big ordeal.

If he's not willing to discuss the matter, then yeah, I would jump ship, as this is a sign of things to come. For me, it is very important to have a GI I can communicate with.

Oh, and no, your surgeon was not lax.

Jan Smiler
CTBarristerCTBarristerMember
quote:
but I'd like to hear if I'm being a baby!


This kind of question is fairly common on this board. I am not going to judge whether it is babyish or not but rather point out what is usually pointed out:

1. Make sure you got the prep instructions right and that they were not communicated by a secretary or other middle person who goofed and gave you the wrong instrcutions.

2. Different GIs have different prep regimens. However it is in your interest to be clean for the scope. "Minimalist approaches" may be more comfortable for you, but what is more important, your comfort level with the prep or the GI being able to have a clean scope and a clean look?

3. My prep is liquid diet after lunch the day before, Fleet enema the morning of. It has produced a clean pouch. Some GIs do not like seeing dribs and drabs of stool. Last time I was in the recovery room at the local endoscopy center where mine was done, my Doc was late for the procedure, so they stuck me there. I overheard a Doc lecturing a guy who was post colonscopy in recovery room. They saw some ulcers but could not get a clean look at some of them because there was stool in the colon and they did not know exactly what was going on. Doc was telling the guy this and the guy sounded stressed out. Do you really want to have this kind of conversation?

4. Get on a scope cycle and discuss it with the Doc especially in light of the cancer risk in the retained rectal cuff.

Good luck with it.
Last edited by CTBarrister
Scott FScott FMember
My GI does it in the endoscopy center, because that's where his equipment is. It's a little more fuss than an in-office procedure, but he sure doesn't order an overblown prep or sedation. Some clean-up with an enema is reasonable, and some folks here strongly prefer sedation (particularly in the presence of a stricture or fissure). IMO sedation makes no sense unless you want it.
Jan DollarJan DollarModerator, RN, retired
Don't write him off without first giving him a chance to get it right, as this is a common issue (where the staff are on "auto-pilot") but the GI doc is really sharp in regard to his skills, etc.

But, if you feel like there is no rapport even without this issue, then certainly look elsewhere. I just didn't want you to think that this is an indication that this guy is an idiot or something. Sometimes even if the doctor is great, if his staff are impossible to deal with, that can be a deal breaker too!

Jan Smiler
vanessavyvanessavyMember
I don't have to do a prep. I was awake for my last scope and had just eaten so they used more water sprayed in places to view. I watched it all. I had no clue I was getting scoped then. I have a BCIR but they are all pouches.

One doctor gave me directions and I didn't follow them and did what I normally do, nothing.

I believe it is just a standard print out they give everyone, thinking we have colons.
CS Claudia SMember

New member in 2015 but you answered my questions from 2013 about being scoped next week! I had similarities with Member/Silo City. My Dr/Surgeon also retired did yearly in-office simple prep for scopes. Since his retirement I have delayed yearly scoping an finding those rare Doctor's who are familiar with J pouch scoping. After reading postings I'm not as concerned with receiving (over-prep) instructions including IV's, sedation's, arranged transportation etc..that are standard an more common with the full colonoscopy. I will now contact my new GI office and see if any adjustments need/can to be addressed due to the difference of my J-pouch.   Love this site! 

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