Dialysis and Safe Preparation for a Colonoscopy

Over the past month my hemoglobin (Hb) level dropped unexpectedly from a powerful and red-blooded 13 g/L to a feeble and anaemic 8.5 g/L over a three week period.  The big question was: why?

The first thing that occurs to most medicos is that the drop has been caused by blood loss, if not from some obvious wound, then maybe for somewhere more subtle, like the bowel or intestines.  Blood loss via the bowel may not be in liquid form, but rather (not to put too fine a point on it) in the form of black poo.  “No black poo here” I said.  Still, there may be a leak somewhere else, so just to be sure, it was deemed time for both a gastroscopy and a colonoscopy.

A gastroscopy is an examination of the inside of the oesophagus, stomach and duodenum.   The oesophagus is the tube connecting the back of the throat to the stomach, also called gullet – which is a great word: “Snow White’s poorly chewed apple stuck in her gullet” – who doesn’t feel that in the back of their throat?).  The duodenum is a chamber at the base of the stomach where semi digested food from the stomach enters the intestines to complete digestion.

Gastroscopy: the big picture (thanks to HCF)

The gastroscopy is performed using a thin, flexible plastic tube with a tiny digital camera and light at one end.  The tube is passed through the mouth and allows the doctor to see if there is any damage to the lining of the oesophagus or stomach, and whether there are any ulcers in the stomach or duodenum.

A colonoscopy is an examination of the large bowel and part of the small bowel.

Colonoscopy: the big picture (thanks to HCF)

The colonoscopy is performed using a long, firm and flexible plastic tube with a tiny digital camera and light at one end passed through the anus.  As well as looking for sources of blood loss, it can be used to look for colon polyps (growths on the lining of the colon) or cancer of the colon, and to help diagnose symptoms such as unexplained diarrhoea or abdominal pain

In both cases, the gastroenterologist carefully guides each instrument in the appropriate direction (from the top down or the bottom up), to look around inside. The picture from the camera appears on a monitor to provide a clear, magnified view.

For both procedures preparation is required, one a little more dramatic than the other (detailed prep instructions are usually provided when you book in for the procedure).

For the gastroscopy, I was told not to eat or drink anything for up to eight hours before the test, so that my stomach was empty to allow the doc to see the entire area and to decrease the possibility of food or fluid being vomited into the lungs while I was under sedation (called aspiration).  That seemed pretty simple.

For the colonoscopy things are a little messier.  For this procedure, I had to completely empty my bowels.  This cannot be done without help, usually in the form of a purgative (a dose of salts and chemicals that evacuates the bowels).  The difficulty is that the purgative reduces everything to fluid using the water I usually carry in my body, to the extent that I could lose 1-2 litres of fluid in a few hours.

This is bad for everyone, because if this fluid is not replaced as it is lost, we can become dehydrated, often without realising it.  Symptoms can range from mild to major, starting with confusion, headaches, dizziness and weakness, getting progressively worse, to coma, organ failure, and even death.  Dehydration during prep is more common than you imagine.  I know several people who were put on drips as soon as they arrived for the test because they arrived dehydrated.

For us BigD-ers, there is an added danger: even mild dehydration can cause our fistula to clot.

So the trick is to balance fluid loss with intake.  Normally I try not to get more than 1.5 to 2 kg over my base weight.  That means I can drink 1 – 2 litres of fluid between dialysis sessions and keep well.  During the last day before the procedure I was losing at least that much in a few hours, so I needed way to replace the fluid lost each time I went to the loo (which was often).  This is where my bathroom scales came in handy.  As I dashed to the toilet, I would jump on the scales and weigh myself.  After the action blew over, I would weigh myself again, work out the difference, and then drink at least that amount of fluid.  eg, if I lost .25 a kilo, I would drink 250 -330ml of water; half a kilo, 500-plus ml and so on.

The result of this Toilet-Scale Dance was that I weighed about a kilo above my base weight when I was wheeled into the theatre, which I think was just right.  All went well.  My body was well prepared; I slept like a baby (I quite like that feeling of unconsciousness rolling over me as the anaesthetic takes over!).  I woke up about 90 minutes later, feeling fine.

A little later the gastroenterologist arrived and told me they had found nothing untoward.  Though as a final test, I will be asked to swallow a camera pill to check out the so far unexplored central regions between my duodenum and the small bowel.  I’m looking forward to that experience.

My thinking on the matter is that I am just over-sensitive to changes in Aranesp (synthetic erythropoietin – EPO) used to increase my red blood cell levels).  My doctor stopped my Aranesp as soon as my Hb was found to be 13, and maybe it was stopped for too long.  This may well be the answer, especially if pill-cam comes up clean (so to speak).

In the meantime, if you have a colonoscopy scheduled, get ready to learn the steps of the Toilet-Scale Dance and stay well.

11 thoughts on “Dialysis and Safe Preparation for a Colonoscopy

  1. Doctors stopping EPO…. grrrr. I had exactly the same thing, and it took months to get the resulting anaemia sorted out. Fortunately I didn’t get referred for -oscopies. I strongly suggest patients ask their doctor to reduce the dose, rather than stopping it altogether when Hb reaches the upper limts. Low Hb can be utterly debilitating, and as the effects of EPO can take several weeks to build back up it can be a problem your stuck with for a while.

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  2. Pingback: Dialysis and Safe Preparation for a Colonoscopy - Home Dialyzors United

  3. Same thing happened to my mom years ago B4 THE big d….but we did all that….and then they send you for the camera pill….ours was at UCI…..in california…..after all that….they still found NOTHING….and the whole time we did all 3 procedures mom told me that (there is nothing there….its all diabetes and kidney failure related….and this is all for nothing…..ha.)

    so we ruled out everything…and it was just that…..related to EPO or whatnot….she got a new kidney doc from the deal….he put her on Procrit….we are not on it now….but it had to do with all that. But this other kidney doc….just let it go from like 13 ,14 to a 6 number I think it was…where they sent her to the ER….well actually her primary did as soon as labs came through…for a blood transfusion…not fun….the doc who was supposed to pay attention to the numbers, wasn’t.

    as far as the camera pill…..even though we “looked” for it later…..never did see it…..for all i know its still in her (just kidding)….it makes you nervous though, because if you dont see it later….it could have got lodged somewhere….who knows….

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    • Thanks Colleen. Yes, a lot of drama and discomfort for sweet nothing. Maybe I’ll take a photo of the before pill-cam rather than hoping to catch it after.

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      • hahah, thats funny:) yeah, it was like a little light bulb…..mom was really stressing b4 swallowing it, I was so afraid it would get stuck…then we spent DAYS looking for it (you get the picture)…..meticulously, have no idea where it disappeared to!
        When we walked out of there with this contraption taped all around her (you’ll see, ha), she looked like a science experiment…..the whole time I kept thinking “this POOR WOMAN”….SHES probably thinking…what the hell have I done in life to deserve this? I know, it could be worse, but it is rather funny at the time.

        After the humiliation of the colonoscopy….I have no idea how she would have navigated the water issues actually for dialysis patients. Wow, that would be hard. I am glad we did it before that started (and the endo). But she did end up having a second colonoscopy and now they say they don’t think she needs to do it again at this point. But the camera pill she could have done without…ha. You could probably pick her up from space, hee.

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  4. The Toilet-Scales Dance lol. But a clever move because you really kept in rhythm with body and the demands! And good and entertaining advice for those who need to know these important steps 🙂 and result was a good one on all counts
    Marg

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  5. Pingback: Dialysis and the Pill Cam | Big D and Me

    • Hi Virginia. The fluids are ok, but it is best to tell the clinician giving you all the preparation that you are on dialysis and can only take a restricted amount of fluids. You are not Robinson Crusoe here, and he/she should know the standard colonoscopy preparation procedure when dealing with people on dialysis. If not, ask for someone who does! Regards, Greg

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