Mild dementia and coping with taking meds for CT colonoscopy virtual

[RoseMartha]

The doctor explained procedure at the hospital, but not about taking the meds in the two days prior.
When we got home I read about it.
There is no way she will follow three pages of instructions and cope with explosive diahorrea for 48 hours, nor would my sister or I be able to cope with her as mum goes to pieces at the slightest thing. (We also have kids and I would have to take mine with me, there is one loo).She would be shaking, disorientated, agitated, angry, and very depressed.
We tried calling hospital to see if she can be admitted for this but the consultant was not available and the scanning department were not helpful. She would need to be admitted monday.
We are wondering if she should have it at all , mum does not want it now she knows what is involved. Should we encourage her to have it as doctor thinks it is necessary due to symptoms or not?

Any advice welcome.

Hi Rose

Disclaimer - I recently had a whole bunch of unnecessary investigations so a bit hypersensitive about this kind of thing.

I'm wondering what the symptoms are, what they're looking for etc. Also how old is your mum, it can take a while to recover from this. Don't be afraid to question if it's necessary. Mum had IBS years ago, she had loads of investigations but they never found anything, she just has to be very careful with her diet.

There was a thread about a poster having an endoscopy to diagnose something that was treatable with diet, but they wanted the endoscopy to look at her gut bacteria or something? So not a diagnostic tool in her case. Def a situation where I'd refuse an invasive procedure. Just flagging it up to say there's all sorts of stuff that goes on.

I would try contacting her GP to discuss this.
Someone needs to weigh up the risks versus the benefits here. Nobody can insist she goes ahead with the procedure so there is a right to refuse investigations unless there are going to be clear benefits from going ahead.
Agree admission prior to procedure seems a sensible solution. I also agree you and your sister should not get involved in trying to deal with the practicalities of this.

Thanks for replies. Symptoms: She is petite and lost a stone without dieting since November, change in bowel habits, tenderness when examined by doctor, anaemia with high white blood count, bleeding but we dont know where from (gynae said uterus etc ok), feels unwell but cant describe, increased urination and urine retention.

They want to check for cancer primarily.

I would give the department a call and explain she won't manage with it. I have admitted patients on my ward for 'bowel prep' who were elderly and/or had dementia and wouldn't manage the meds so I'm sure you wouldn't be the first. Give them a ring and see what they can do.

Sorry just read the last part of your message. I would say she does need it done so would call again on Monday and keep trying. It would be better to get diagnosis rather than delay it or cancel it. The investigations don't get any easier unfortunately.

I have had a colonoscopy done three times the first time with the foul pre-prep over a couple of days but the last two times with an enema in the clinic.
You just have the enema inserted wait for 10 mins ( or 8 in my case ) and then go to the loo.
Much more civilised .
Can you ask the clinic if that’s possible and also ask about sedation just to make it easier. I understand that it’s very light and not full unconsciousness.
Wishing her well.

I think she needs to be admitted. I've had several colonoscopies and the bowel prep really is grim - it would frighten a person who didn't really know what was going on. There's also the issue of dignity - it's pretty messy and could distress her and the grandchildren as well as being better dealt with by a professional, perhaps. Ring the ward on Monday and request it; could you also enlist her GP's help in getting her admitted?

Rosemartha phone the CT department, explain the situation. They should be able to do a CT colon with minimal prep, so she wouldn't need the laxative meds. They would probably still want her on the low-residue diet, and might want her to drink some fluid (shows up in the bowel but no effect on her).

I do this for a living 😃

And it is not the same as endoscopy, it is a 20min procedure, no need for sedation, no recovery needed (other than a cup of tea and a sandwich as patients are usually very hungry! )

I guess the question is, if she isn't fit enough to tolerate bowel prep, would she be fit enough to tolerate an operation to remove a bowel cancer? Because that's ultimately what they will be trying to rule out with unexplained weight loss.

Just because we CAN do things doesn't mean we always SHOULD. I'd think about this with the rest of the family.
If it were me with dementia having to be looked after, I'd probably want to be left alone.

(Doctor)

I'm with hipho, will the tests result in a change to the proposed treatment plan?

If not, why do it?

Definitely worth discussing with her doctors. Also, if it is necessary, it's absolutely normal for admission for the prep as well as the procedure in people who wouldn't cope with it as an outpatient.

Back in the day it was routine to be admitted for prep if you were diabetic or frail (old HCP here)

Another HCP agreeing with hippo. You could be opening a can of worms here. If the worst was confirmed, could she cope with a stoma for example, if needed? Medical science is marvellous but I often feel focuses on prolonging quantity rather than quality of life. Good luck with it all.

Ginfox - I think there's a few of us who would say the colonoscopy plus prep is far worse than an endoscopy.

OP I was wondering about your mum's age partly because I too thought that if it is cancer, will it be right to treat it anyway? sorry you have so much to think about.

Grace this isn't a colonoscopy or an endoscopy, it's a CT scan.

Thanks for your helpful replies. I appreciate them. A lot to think about but definitely i need to contact hospital monday and explain situation.
She is mid eighties
Also has multiple other health issues and takes 12 different types of medication a day.

Hi @RoseMartha. My Mum is in her late 80s, has mild dementia (and very limited mobility) and has had two colonoscopies in the last 6 months. I assisted with the prep, and while it wasn't pleasant it wasn't as bad as we thought. The 'explosion' only lasted a couple of hours on each occasion, and while her lack of mobility was a definite problem (she can't dash to the toilet when things start to happen, so she had to sit right outside the toilet for quite while), she withstood the prep reasonably well.

She was heavily sedated for both actual colonoscopies and they went reasonably; she remembers nothing about the procedures (which was a blessing!).

She was diagnosed with Colitis and they also found abnormal cells (early signs of cancer). The latter has raised difficult questions for us as I don't think that she will be able to deal with an op, so at the moment it is just being monitored. Good luck whatever you decide.

I should have added that the second time round the hospital offered for her to have the prep done in hospital. We refused because felt that it wasn’t too bad and would be worse for Mum to have to go into hospital.

Thank you @MrsCat1

Just to say she was admitted for that and endoscopy. I dont think she would have managed at home. No results yet.

so did your mum have to do any prep?

fingers crossed for good results.

Yes but they did the prep in hospital. So that was good.

Thank you