PEG

I’m having my second ever colonoscopy on Friday. Or I’m supposed to at least.

PEG is such an innocent sounding word. Reminiscent of what is at the moment a sort of ironic song, or an ironic bit of lyrics. “Peg, it will come back to you…” And indeed, it may if what might be coming back (up) is your clear liquid dinner.

Really, it should be PEIG, which stands for “Plastic-like Emesis Inducing Gunk”. Why a PE(I)G prep? Why indeed.
From EndoNurse
In a recent attempt to assess which bowel preparation agent is most effective, researchers conducted a meta-analysis by pulling studies that were published between January 1990 and July 2005.2 The meta-analysis discovered that sodium phosphate (NaP) was more effective in bowel cleansing than polyethylene glycol (PEG) or sodium picosulphate (SPS). Patients showed more difficulty completing PEG than NaP and SPS. All three were comparable in terms of adverse events, with PEG resulting in slightly more adverse events than SPS. NaP resulted in more asymptomatic hypokalemia and hyperphosphatemia than the other two, leaving the researchers to conclude that “the biochemical changes associated with a small-volume preparation like NaP, albeit largely asymptomatic, mandate caution in patients with cardiovascular or renal impairment.”

I have no cardiovascular or renal impairment. So, ummm, why am I getting the PEG prep? My theory is that I am getting the prep which is standard when the clinician assumes the patient is likely to be overweight, hypertensive, and possibly older (male). Sorry if that sounds mean. Any hostility comes from my irritation that male is still too often the medical standard, and I have some issues about which populations are sampled and then generalized to in research in general.

Anyhow, I’m not in that set – the set being people who you should give a crappier prep to because the crappiness of the prep is overshadowed by the need to not pump this person full of salt. I’m a skinny, hypotensive mid-thirties woman who fills up so fast she usually can’t eat a whole meal at a time and who has a history of low Na levels.

Is this an example of one size fits all medicine or does my GI doctors office know something they should perhaps share? I’m too tired to push the issue. I’m going to try to get this shit down and keep it down, but if I end up not adequately prepped because my doctor’s office insisted on a crappy prep for crappy reasons I’m probably not going to be feeling terribly compliant…at least not for a little while since I already asked once “er, do I really have to do the PEG prep?”

My prep instructions tell me that “if vomiting persists, stop the prep and call our office for instructions”. When my GI’s office calls back about the Donnatal/anticholinergic/antispasmodic issue, I’m planning on asking exactly how many times a person must vomit before we consider it to have persisted.

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