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Not able to get to use a commode at all? How can any prep be done at home? I can't see how that is possible! Right now a caseworker is trying to get the insurance company to approve a stay at the facility to get the job done. If they don't approve this, I just can't see how this can happen here at home!! Help!

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No, not really. Home health doctor was here this week and she said she is going to contact the case worker again about a GI consult. We are kind of on hold about the whole decision to go ahead with colonoscopy until further notice from the doctor. It really is frustrating to have to wait so long to hear from the health care professionals. We of course will stick with our decision to NOT be responsible for the prep here at home. Just cannot do that especially with my 92yr old father living here too. I guess my brother can refuse the procedure and accept what goes along with that decision. I am just trying to get through each day with no major trauma from both guys in the house! Thanks to everyone for your advice and comments. It really does help to hear what others have to say that are in the same situation.
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Anything new with your brother?
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Saturn, my mom recently went 2 weeks before having a BM. I had to take her to the ER where they gave her lactulose (go figure!) and she went the very next day.
There was a little blood in her stool and some of the health care people involved were all up in arms, worried and all. But it didn't happen again. Sometimes, when I am constipated, there might be a bit of blood on the tp. It doesn't repeat and I've never worried about it.

I am also an RN and in school and in practice, we didn't really worry about blood unless it was obviously blood that had gone through the alimentary canal for some time, maybe from the stomach or upper intestine. But that blood isn't bright red and it has a terrible odor.

There are little cards with reagents that you can use to see if there is blood in the stool BEFORE you and he go through this ordeal to make sure there is something to investigate. A lot of times hemorrhoids or just overstretching and trauma related to the size of the BM after being constipated for so long can cause a little blood, But the thing is, if the blood is bright red, it is not from deep in the body but right inside or outside. If it doesn't repeat or doesn't show up on the little cards (ask the dr for an Rx to get some), then I would either talk to the dr about alternatives and/or get a second opinion!

It seems unnecessary unless there is good reason to suspect something going on. And from what you've said, I think there is more investigation that should be done before having to suffer the prep and aftermath of a colonoscopy.
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if your brother is of clear thinking ability it is his decison. But that he was impacted for 2 weeks without intervention is unfortunate. Yes I think a trip to er is in order. What pain that must be causing him. Let us know how it works out.
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Boy, I dont know how I feel about some theses responses. As I noted above my father was same situation. If he hadnt had this I know he would of passed from the cancer they found, At 78 they were able to get it all out (colorectal) and he lived cancer free for 8yrs, He died from other problems. I am so thankful to have had him around those extra yrs. I think decisions should depend on situations,and of course individuals health and decision of treatments if something were found.....It is a shame Medicare wont pay for short stay for these pts, our Dr would of admitted dad if so. but they woudnt pay for admit for "diagnostic or exploratory procedure" ,at least that was our situation
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Many great comments here - most of all consider how all the drinking/flushing etc. will affect your brother. Can he handle it? Kudos to the family who shared the task by all being there...you are awesome! I would sure be asking more questions of his doctor: Will the test enhance the quality of his life? What will the treatment be if it is cancer? Can your brother withstand the chemo/radiation if it comes to that? My husband at the age of 84 had to have a colonoscopy to check for polyps(sp) - I would never do that to him again. He was uncomfortable the whole time and he drank all the solution, but it was not easy for him. He has Alzheimers and now a brain tumor so for sure he won't have another. It took away his dignity too, not only the constant bathroom runs but the actual procedure. We have a wonderful doctor and she did not push it. We made the choice. Has your brother agreed to this/does he actually understand what will be happening? The bottom line - what is his prognosis? You have lots to consider in this situation. If I had to make the decision for him as my brother, I would not do it - but that is my own personal opinion. I would say call in Hospice and see what they say about his condition before I'd proceed with any rectal testing. The best to you - I hear the caring and concern for him. All caregivers have to make decisions that we don't want to sometimes, but our loved one is top priority and their comfort is what we're about. Sometimes our heart says differently - we've all been there. Know you are loved and we care. Blessings on all caregivers everywhere!
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If nothing else the risk of dehydration should justify hospitalization for the procedure and prep. I too would question if this is worth doing,
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Unfortunately, It is common for those bedridden with MS [or some other ills or meds] to have bowel impactions.
Preventive measures/regular bowel care regimens are crucial to preventing or reducing episodes of this, but measures do fail to do the job sometimes, no matter how well instituted..
Also, paralyzed persons could have parts of intestines twisting or telescoping into itself, which can cause blockages.
But impacted stool is most usual culprit.

IF an impaction happens higher up in the colon, out of reach to dis-impact it, other measures are needed.
Registered Nurses in Nursing Homes often get blessed with doing a "simple" [as-if!] disimpaction. But if a blockage is too high up, or too tightly packed, it requires a Doc to do it, in an acute hospital. Immediately.
And there's no way to get around it--they hurt! In hospital, anesthesia can be used, to reduce pain and relax muscle spasms contributing to it.

It's possible the process of prepping for colonoscopy could help dislodge it, but it would be very hard to pass, and would need assistance by professionals to help clear it--back to his being in an acute hospital for that!

The tools for a colonoscopy could help break it up, to assist clearing it;
but a standard bowel prep for that procedure, is ridiculous--and it still needs anesthesia!!
The Doc may think he could get off the hook if it just "happens" to pass using the prep [met a couple of those sorts!]--again, pretty ridiculous, if that has been there 2+ weeks.
Forcing an impaction to move rapidly through the colon using forceful laxatives is very painful;
IF something else causes a blockage, a colon prep is CONTRA-indicated.

Does he have an NG tube through which to pour the liquids?
Does he have swallowing issues?
Has his stomach shrunk, or have trouble processing food, related to the progress of the MS?
...then, good luck on Standard prepping.
Not even discussing how to handle effluent!
[[have had to set up trashbags funneled to trash cans in the past--DON'T let on anyone told you that solution, lest they think you could safely handle it at home]]

IMHO, DO ask the Doc:
What does Doc suspect is cause?
WHAT other tests or exams has he done so far?
Does Doc think the prep would safely move an impaction of that long-standing?
Does Doc think cancer might be growing / blocking?
Does Doc suspect the bowel telescoped in on itself, or twisted, forming a blockage?
===Those other potential causes would be surgical interventions, NOT a colonoscopy! A colon prep would be bad in those cases.

COULD a less painful prep be used, such as repeated enemas?
COULD your person have a CT scan or MRI instead of colonoscopy, to visualize what's in there, where?
HOW did Doc think This would be handled in a home-care setting, no matter what the cause of the blockage was?
IS this DOC a specialist with MS patients?
Is he up-to-date on knowledge-base regarding care of late-stage MS?
Is Doc experienced in bowel blockages and the various causes?
AND,
If this is one of the usual sorts of bowel impaction common to bedridden MS patients, why doesn't he avoid the Prep, and just go in there to help break it up and remove it, =while the person is in hospital=, instead of torturing the person with a colonoscopy prep?
MAYBE, the Doc was just not thinking clearly at the moment he recommended a colonoscopy--had too much other on his mind, and failed to consider who he was talking about?!

Bottom line, if a bowel blockage is not cleared, it can cause death.
How slow, is question.
Your brother needs fully informed about potential causes of blockage,
potential remedies of it,
choices of procedures to remedy it,
and, potential outcomes,
to give his informed wishes on this.

IMHO, that is NOT a prep or procedure to be done at home--NO WAY!
It at least needs done in the E.R., or in the Acute Hospital.

It is hard to believe a Case Worker is proceeding on seeking Insurance coverage for it; it sounds like not enough information has been gotten, specific to this person, and, that no other options have been considered.
[[Even professionals have brain farts! ]]

Bottom Line:
A bowel blockage of 1 week or more, is an Emergency,
for which a person should probably be brought to the E.R. to get help.
This is even proper procedure, if person in a nursing home had an unresolvable blockage--they get transported to get it handled right.
Make sure he gets: "admitted for diagnosis & treatment of bowel blockage"
---being admitted for that, [[not "observation"]], is one Key thing to make sure Medicare/medicaid covers stay and treatment, according to what others have posted on this site.

Advocacy by family and friends helps keep Docs and Case Workers on the right track; helps prevent some of this ridiculousness
--sometimes, they are just on overload, and are failing to consider some details that could really put them in a bad situation, if they failed to consider them!

You could use statements like:
"It is impossible to do a colon prep on a paralyzed, bedridden person, at home, for an unknown bowel blockage of 2+ weeks duration; we have no way of knowing what is causing the blockage; he needs diagnosed and treated immediately. He can be transported to the E.R. today.".

Please keep us posted!
It sounds like the System is pushing you incorrectly, and it's time to push back!
I sincerely hope it is simply an impaction and fairly easily cleared.
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To nsjmk77- Do you think that when someone has Cancer that the inevitable is death?! I know many survivors of Cancer. I know several who have healed themselves with a change in diet. I don't like the idea that just because someone is diagnosed with Cancer that that is all she wrote. Dang!
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Does your brother want the colonscopy? If not, I would suggest you abide by his wishes. Have you contacted any MS associations to see what their recommendations are, if any? I had a routine colonscopy just 3 days ago and needed a 2-day prep. It was an awful experience, and at my age I don't think I'd do it again. (I'm 71.) Other than the MS, which is serious enough, it is a pretty grueling experience for anyone to go through.
God bless your brother and you.
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I agree with the others on why do it? Ask the doctor what is the worst case scenario(s) they could find on the exam. With those results what would be the treatment? Decide if you would consider the treatment for the findings. If you would not consider the treatment, don't do the tests. I realize your brother is still young but if he has cancer is he going to want to go through radiation and/or chemo the prolong the inevitable? Once you answer these questions then make a decision on the test.
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I would be asking the doctor who ordered this what his recommendation is on how they go about handling a problem like this. If he can't give you a reasonable and manageable answer then ask him to come do it for you! Idiot doctor's don't ever care or think about the trouble all this creates, just as long as they get paid!
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I am so sorry that you are dealing with this. I would not put him through it.
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The first question to ask when deciding what to do about a given procedure is - will it improved the quality of the patient's life? In your case it sounds like the answer may be no. He is bedridden with MS. How is a colonoscopy going to accomplish anything other than prolong a life that is already bad? It seems to me that the doctors are either trying to cover themselves or pad their pocketbooks.
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Thanks for all the comments but I should explain. I am speaking of my brother who has MS. He is turning 60 next month and recently had 2 stool cultures done because of his history of constipation and c-diff(Last year) Both tests were sent to different labs and AFTER 2 weeks of not going to the bathroom. One doctors office called back about blood in the stool. So his home doctor has said he really should have the colonoscopy to check it out and she is the one that is trying to get him in hospital for test. No word back yet. I know we can refuse it and that might be the case here. I really admire the family that tackled the job but I just don't see that happening here. I want what is best for him-just not sure putting him and us thru this is the best decision right now??
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wow. My mom wants one every year for stomachaches. Its always negative. I don't go in the dr's actual appt.ment with her cause we get into a big fight. But that law will surely help a lot of people. Thanks for finding that out. Hugs to you.
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This is a quote from a recent New York Times article:
"the United States Preventive Services Task Force reviewed years of research and recommended against routine screening for colorectal cancer in adults over age 75 and against any screening in those over 85."

The risks far outweigh the benefits of colonoscopies in the elderly. Why put a frail person through the trauma and humiliation of prepping for the colonoscopy and the possible delirium resulting from having the procedure?

Here is the link to the article http://newoldage.blogs.nytimes.com/2013/03/12/too-many-colonoscopies-in-the-elderly/

You might want to share it with your loved one's doctor. Ask questions. Find out why he/she thinks this is necessary. Unless there is a very good reason, consider refusing the procedure altogether. And get a second opinion if the doctor is insisting that it be done.
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I'm with Madeaa on this on, incompetent they want money. For my mom she loves getting tests done any tests.I hope it changes. We are getting a new Dr. and I will see if this one does everything she wants. Or see's the light.
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Sounds like he should be hospitalized for such a procedure. My mom was able to sit on a portable commode that I had for knee surgery months before, I don't know how you all do it and should be commended for it. I wish you all the luck in the world.
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I'm with ba8alou, why was the colonoscopy ordered? What does your doctor hope to learn by having the colonoscopy done? Did the doctor provide you with risks and benefits of the colonscopy? It is tough prep for anyone, especially tough if the person is debilitated. There is always risk in having any invasive procedure. Does the benefit of doing the colonoscopy outweigh the risks to your family member and hassle of the prep for you? You can always decline the test if you aren't convinced of the benefit to your loved one. Good luck.
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Does this person Really need this? Are they having a GI bleed? Anemia from a suspected GI bleed? American medicine is of the mind that "something" must always be done. But is that really the case.
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Again, some doctors amaze me, are they too busy, or are they incompetent. I would think the doctor would be aware of the situation and why he'd call for this prep at home is beyond me.
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I'd be asking why too. FIL's doc told us that they try not to do them after age 80 (he is 87) because of the high risks involved .Seems like a lot to put someone through who is already frail.
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my father was immobile and denied stay prior to his exam and we succeeded in giving him his prep, two seperate times. He also had bowel cancer so his sensation of having to go was off. It was a challenge and a messy one. I had a team of mom,sister & myself. When the urge came on , we placed him on a bedpan. and had 2 backup pans which we kept switching.while cleaning him & changing bed disposable liners (underpads). Somewhat like running a relay race or assembly line formation. Each of us had a certain job to do, it took about 4 busy (messy)hours . The rest time not too bad. . I suggest to have lots of backup supplies:gloves,paper towels, TP, Skin cleanser, underpads, depends,bedpans,sheets etc. Masks if you have sensitive stomach. Its not pleasant experience but we survived! twice!! Good Luck & Hope your insurance comes through for a stay
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Why does this person need a colonoscopy?
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