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I need to prepare a dementia patient with rectal prolapse for a procedure. The preparatom is identical to a Colonoscopy. We hoped for the hospital but the insurance doesn't cover this. Any tips? How to wash down the solution? To organize it properly?

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I would speak to her doctors & have her admitted prior to the procedure, maybe begin an IV and have her go with a clear liquid diet for several days prior & then start the “yucky, awful” prep solution & maybe with the clear liquid diet several days before, she will be able to be cleared out well enough to have the procedure.
I can’t see any other way to clean her out. The prep is nasty.
Hope it works out for her!
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Tx veronica that was Great advice!
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I recently had to go through that prep. My pharmacy did not have the flavored version. The pharmacist warned me that it would stink like sulfur when I'm drinking it. Best to cover my nose while gulping it down. Better get the lemon-flavored one that the others mentioned.

I had verbal and written instructions from the surgery center about 1 week before my colonoscopy. The nurse explained to me what I needed to drink, no eat, not drink, etc... What time to start the prep, etc....I was instructed to fill the whole gallon, but the surgeon's nurse told me that I just have to finish half the gallon. (Other people I spoke to - had to finish the whole gallon.) After each set of instructions, she would ask me if I had any questions. For my prep, drinking starts at noon before the procedure. I had no problem with 12noon, 1pm, 2pm. By 3pm, my stomach was not very happy with the silver taste. By 4pm, I was gagging while forcing myself to drink it. By 5pm, I was leaning over the sink, fighting hard not to throw it all back up. It took me longer to finish the cup... What I'm trying to say is - if I remember my mom, who had dementia. When she didn't like something, she would clamp her mouth shut and refused to open it. Will the dementia patient, like my mom, clamp her mouth and refuse to drink full glasses over and over within several hours?
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Re: insurance appeal. My husband is on blood thinners. He has to go off them in order to have polyps removed if they find any during a colonoscopy. The insurance company originally denied certification for what turned out to be a three day hospital stay at Sloan Kettering for the surgery, but we simply bombarded them with evidence that doing this procedure on an outpatient basis was simply too dangerous.

Don't take "no" for an answer.
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The low residue diet is not too bad, the citric acid solution tastes like Tang, but the effect of it is a nightmare for someone in their right mind.

I would ask if there is any other options for the prep. I was told that if I ever need to 'prep' again I can avoid the citric acid stuff, but I have chronic IBS.

Ask if she eats a low residue diet for a week instead of a few days and a clean liquid, tea, coffee (no milk), broth, Jello etc. for a couple days if it would be adequate?

First though I would ask what is the prognosis if she does not have the procedure? What is the prognosis if she has the procedure? General Anesthesia is not great for seniors and for someone with dementia it may worsen their symptoms.
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I agree; I'm baffled that they can reject a claim for something that is integral to successful treatment.
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CM, I understand that she's not having a colonoscopy. She's having the same prep as for a colonoscopy. There should be an appeal to the insurance company for this to be done "in house" with medical supervision and probably sedation.
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This is just one of many, many examples I've seen of doctor's who don't specialize in dementia not having a clue. Hospitals are as bad. I sure hope those attitudes are changing, but I worry that it won't really happen until we have a whole new generation of medical professionals.
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I think that doctor should come up with another way to achieve the prep goal. I cannot imagine either my mother or my husband being able to comply when they had dementia.
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Barb, the lady isn't having a colonoscopy - she has a rectal prolapse of over 5 years' duration, and the pre-op process for surgery is the same, apparently. I'm wriggling in my chair just from empathising so I dread to think how badly the poor lady must need this done.
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If she won't drink the fluid no professional will not be able to get it down.

CM it is about a gallon, one glass every 20 minutes.

There are pills that can be given instead of the liquid but I believe there are about 20 so that is another problem.
It may be possible to cleanout with numerous enemas.
Depending on the stage of the patient's dementia is it actually a good idea to do the surgery.
You really need to discuss all this with her gastroenterologist.
Washout could even be done once she is anesthetized. She could take something like Miralax for a few days before and a low residue diet for about a week. Personally I did not find the prep liquid too foul. it was slightly sweet and lemon flavored. I just sat on the toilet for the duration and kept drinking.
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I just can't imagine doing a colonoscopy level prep with a dementia patient. It seems cruel and unusual.

My mom had her last colonoscopy at the age of 85, pre-cognitive decline. She came out of the anesthesia and said to me "I'm never doing this again". The GI doc showed up a minute later and said "you never have to do this again". We laughed and said we were glad that we were all in agreement.

Who thinks that this is necessary?
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On second thoughts - can you not find the money anywhere just to pay for the pre-op care? The idea that an untrained caregiver can handle this strikes me as insane; and I assume her prolapse has now turned so nasty that the surgery is absolutely unavoidable?
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Well. If your mother's health insurance won't cover her for skilled nursing in preparation for this, you'd better track down an experienced nurse and beg or pay for her help.

How much fluid do you have to get down her, and in what time frame, and what happens if you can't?
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All kinds of post operation has been taken care of by the hospital. It is just the preparation for the procedure that I know. Just some tips how to trick patient into drinking that amount of fluid. Not to panick with cramps etc.
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I would think the doctor performing this would be the best source. Does this doctor have a nurse or staff member who "boards" surgeries and provides pre and post-op advice.

This is a question that's really too specific to be answered on a nonmedical forum.
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