I had a colonoscopy a couple of days ago. By the time I was put under anesthesia, I was off my 15mg Mounjaro for eight days. I also stayed on clear liquids for three days before the procedure. Others not on the meds are on liquids only the day before. Delightfully, I was not one tiny bit hungry during those three days. This shocked the nurses at the surgi-center. Two days before the Prep, I took a hefty dose of Milk of Magnesia and two laxatives to get the ball rolling (it worked!). I was NPO (nothing by mouth) for 6 hours before I went to the surgery center compared to the two hours of those not on the GLP-1s.
Some of this odd routine was my doing because I knew if I had anything in my stomach or bowels, they would cancel the surgery and I would have to do it all over again. I was not taking any chances with possibly repeating the ghastly “Prep” of a colonoscopy.
(Read about my pre-Prep, Prep, and Colonoscopy experience below the medical talk.)
A Whole New Complication of GLP-1s
Anesthesiologists recently set off alarms regarding people on GLP-1s going under anesthesia for surgeries. GLP-1s can include, but are not limited to, Mounjaro, Zepbound, Ozempic and Wegovy. The doctors were finding “high residual gastric content,” aka food and/or fluid left in the stomach and/or intestines when they should have been long gone. This is “a major risk factor for aspiration under anesthesia.” Aspiration is inhaling the contents of the stomach into the lungs which does not always mean something bad will happen, but can be extremely serious if it becomes pneumonia. In rare cases, the pneumonia can cause death.
In Anesthesia and Analgesia ‘s article “Anesthetic Considerations in Adult Patients on Glucagon-Like Peptide-1 Receptor Agonists: Gastrointestinal Focus,” this short paragraph highlights the crux of the issue.
Glucagon-like peptide 1 receptor agonists (GLP-1RAs) are successful in treating type 2 diabetes mellitus and obesity. However, their use can increase the risk of regurgitation and pulmonary aspiration of gastric contents during sedation or general anesthesia.”
An October 2023 article in Wolters Kluwer offers even more information: “Expert anesthesiologist provides guidance for perioperative care of patients on GLP-1RA therapy,” . The anesthesiologist is Girish P. Joshi, MBBS, MD, FFARCSI, Professor of Anesthesiology and Pain Management at the University of Texas Southwestern Medical Center in Dallas.
Delayed gastric emptying and ileus can increase the residual gastric volume (RGV) even if preoperative fasting recommendations are followed, Dr. Joshi warns.
It was for this reason I was meticulous with my preparation before the colonoscopy.
Advice So New, It’s Constantly Changing
At first, the advice was to stop the GLP-1 medication a week before the surgery. Of course, this cannot be done with an emergency surgery, so the anesthesiologist is the one on the highest alert (as they always are anyway) during the procedure.
Dr. Joshi says:
The concern about pulmonary aspiration has led to the notion that the longer the fast the safer it is for the patient,” Dr. Joshi says. However, “intake of clear liquids may paradoxically reduce RGV. Furthermore, even if regurgitation and aspiration of clear fluid occurs, it is unlikely to result in significant morbidity.” To date there is no evidence about the optimal fasting duration for patients on GLP-1RAs, Dr. Joshi says, and his group’s new guidelines suggest following the standard ASA fasting guidelines. (emphasis mine)
These guidelines state in part:
Healthy adults should drink carbohydrate-containing clear liquids (simple or complex) until 2 hours before elective procedures. This was a “strong” recommendation based on moderate evidence suggesting that these patients experienced less hunger and thirst than did fasting patients, and less hunger than did those who drank noncaloric clear liquids.
Where Confusion About Stopping GLP-1s Comes In
In a WebMD article entitled, “Should You Stop Taking Ozempic Before Surgery?,” says that doctors are so unsure about what to do, they are asking each other on X (formerly Twitter) what to do!
…doctors are trying to figure out if they should tell people to stop taking these medicines — also known as glucagon-like peptide 1 receptor agonists or GLP-1s — 12 hours, 24 hours, or up to 2 weeks before planned surgery.
This demonstrates exactly how precarious surgery on GLP-1s can be. Our post-surgical health might depend on who is giving us the advice of when to go off the medications and when to go NPO.
Erring on the Side of Caution
This is why I went overboard stopping the Mounjaro eight days before, drinking clear liquids for three days, taking Milk of Magnesia and a laxative two days before the Prep, and then NPO for six hours before the colonoscopy. It was partly so they didn’t reschedule the procedure, but also to protect my own health and safety.
What Started All of This In the First Place (Might be TMI)
I had some helacious diarrhea between being on Trulicity and Mounjaro. Not sure why, but there it was. I had bleeding and considered going to the hospital, but took a LOT of Immodium AD and the diarrhea stopped. The bleeding seem to have gone away, but when I had my Hematology labs, it showed I was bleeding somewhere so I thought I should take a home fecal occult blood test for colorectal cancer (bought from Amazon for $32, with two test kits inside). When I did, it came up positive for blood. Ugh. I had an iron infusion to see if that helped my blood levels, but once again, it showed I was bleeding somewhere. I did another fecal occult blood test and again, it was positive for blood. By the way, the testing was so easy. Don’t hesitate to take test. It really was simple and not gross at all.
So I scheduled the colonoscopy.
What My Preparation Looked Like
For grins and jollies, I thought I would share how I prepared for the colonoscopy. I’m sure I made it more complicated than it had to be, but I wanted everything to go like clockwork. These pictures will tell the story… all of it leading up to The Prep… drinking the colonoscopy prep drink Clenpiq the night before the procedure.
The Prep
Colonoscopy Preps are notoriously disgusting. There are several types of preps that require you to drink a gallon of liquid laxative over several hours (not exaggerating the amount) and then there are ones like I had that are smaller amounts, but equally as vile tasting, drunk in two separate sessions a few hours apart.
There is a pill version for doing the cleanse, but for some bizarre reason, doctors don’t like to prescribe it.
You would think that after 50 years of doing colonoscopies, one palatable way to do the prep would have been discovered.
Colonoscopy Prep Preparation
After you drink the laxative or, if you are lucky, take the laxative pills, you are on the toilet for a while. A long while sometimes. Because of this, I thought it would be great to set the stage for a long stay in the bathroom with some care and comfort.
I spent an inordinate amount of money on the supplies people on the Internet recommended one obtain for their prep. Looking back, I’m laughing at just how seriously I took this, all for a procedure that took an hour. I promise, the actual colonoscopy was the downhill slide of the whole experience. Once the prep is done and you get to the doctor without crapping your undies, it’s easy peasy from there.
Supplies I obtained for the baño excursion:
- Baby Wipes
- Dude Wipes (too many)
- Preparation H (way too much)
- Butt Paste (Dimethicone and zinc oxide… the best thing I got for my butt out of everything.)
- Tucks (way too many of them)
- Propel Electrolyte Drink (lemonade because you cannot drink anything red or purple before a colonoscopy)
- BodyArmor Electrolyte Drink (Lemon-Lime – I liked this lots, mixed one cold bottle with cold water. I had 6, should have had more. Remember, I drank clear fluids for three days ahead of the procedure.)
- Isopure Protein Powder (I drink this anyway, but got the Tropical Punch flavor since it was a really light pink when mixed with water.)
- Nitrile Gloves (which I never used)
- Charmin Soft TP (used almost two rolls!)
Colonoscopy Prep Ambiance
With the supplies mentioned above, I brought in sweet-smelling candles. We all know why those were a welcome addition. Doesn’t that look pretty?
The Clenpiq Prep Itself
The Clenpiq Prep comes in two 5.5 ounce bottles. I had to drink the first one at 5:00pm the night before the procedure. The second one was at 11:00pm. At first, I was doing okay drinking it, reminding myself of the last two colonoscopies I had when I had to drink a gallon of disgustingness. This was going to be much easier.
Apparently, Clenpiq comes in a couple of different flavors. I got one that was supposed to be “flavorless.” While there was no “flavor,” it tasted like someone poured half a cup of sugar and a half a cup of salt into 5.5 ounces of water. I chased it with the icy Propel lemonade, but it was still gross as all get out. I glugged it down as fast as I could.
Because I had been on liquids for three days and had taken the MoM/laxative cocktail, all the poop I had was pure liquid. Nothing dark. The goal of the Prep (as if we have any control at all over the results) is to have clear water in the toilet. A yellowish tinge is normal because of the bile from the colon, but clear is better. During the experience, I learned that flecks of something that looks like small spider webs is normal, too. I Googled what the heck those things were in the toilet, fretting that I would be canceled because of them. It took everything in my power to not take a pic to put here. You can thank me in the comments for not providing that delicate evidence.
I had five BMs over three hours with that first bottle. No biggie, I thought. Maybe I had done a better job of cleaning myself out than I thought!
During the whole ordeal, I drank several re-fillings of my 40-ounce Iron Flask. I alternated between the Isopure Protein Powder and the BodyArmor Lemon Lime Electrolytes (which I loved).
11:00pm arrived and it was time for the second bottle. This time, I gagged it down, trying to gulp it fast, but fearing I was going to vomit, drank smaller swallows, again, chasing it with the Propel lemonade. After choking it all down, I had to lie down to chill so I didn’t barf. Unfortunately, that lasted all of 10 minutes.
From then until 3:30am, I was constantly running back and forth to the bathroom. Now I was really glad for the candles! My bottom hurt and I used the Butt Paste copiously. Needless to say, I did not wear any undies or pants lest I have an accident racing to the toiletten.
Even after I fell asleep at 4:00am, I had to trek to the bathroom three more times before I had to be up and ready to go to the surgery center at 7:30am.
Colonoscopy (Not Graphic)
My first stop was registration and I had the nicest woman. In that office, someone heard I was on Mounjaro and came out to talk to me, telling me she had just started it and peppered me with questions that I answered gleefully. She seemed relieved to know it was all going to be a nice ride and I gave her my card to this blog and if she is reading, welcome!
With every stop I made, I was asked how long I have been off my Mounjaro. “Eight days.” Over and over again.
I was ushered to the scale (wheee! I love the scale now!) where I weighed 204 pounds. That meant I was now down 201 pounds. So mad at myself for not taking a picture of the number on the scale. With that weight, I’d lost four pounds in the last three days! All water weight, for sure.
The whole room was filled with beds, separated by curtains, making separate bays for each of us. The process was clearly a well-oiled machine.
I put on the gown… a regular-sized one! Not a bariatric gown like I have always worn! I was so excited I even took a picture of it after I took it off as proof.
A nurse tried to put an IV line in, but missed so another nurse tried in my hand and got it. I am a hard stick, even after losing 201 pounds. It runs in the family.
Right after the IV was put in, I was wheeled to the procedure room where I met the Certified Registered Nurse Anesthetist (CRNA). He was kind and friendly. I explained that I don’t do well with Versed as a sedative (I’ve remained awake and aware during two endoscopies with Versed) and he said he doesn’t like it either. I asked, “Propofol?” And he said that was what I would have. I was relieved.
While he and I were talking, the room was being set up, the scope pulled out and laid on a table to my right. The assistants in the room moved quietly, but quickly. The doctor came in and I said hello, but he was all business, nodding to me. Speed was clearly of the essence in this space.
I heard the stereo next to me and was glad. I like music when I am going under anesthesia. I used to bring my own CDs to the OR and they would pop them into the player. I’ve played everything from the Mamas and the Papas, Yanni, and Hamilton to Carly Simon, the soundtrack to La Bamba, and Disney music. I said to the CRNA, “Feel free to play whatever you like.” He said, “This is the Talking Heads.” I told him I knew that and liked them, but really love “my” Queen. He said, “Queen is great!” then asked me to turn towards him. I commented that a year ago, and certainly two years ago, I would not have been able to turn so easily. He said I would have been in the hospital to do this. I was glad I was there instead. He said it was time to say goodnight and I was gone.
Next thing I knew, “Bohemian Rhapsody” was playing and I was waking up. What a guy, putting my Queen on for me!
I woke up easily and was taken back to the bay where the IV came out, I got dressed, and the doctor came in with a handful of papers telling me the results including 20 detailed pictures of all parts of my (VERY CLEAN) colon. He said I did a perfect job cleaning myself out. HURRAH!
I had no bleeding. No polyps. AND NO CANCER! I was thrilled! Of course I asked, “When is my next colonoscopy?” His blessed answer? “In five years.” Not until 2029! Woo hoo!
I was out of the surgi-center within 30 minutes of the procedure, wheeled out to my ride (no Ubering after surgeries, apparently) and was home three hours after I left. I felt great!
Realizing I was a bit foggy during the day, I took a good nap before waking up completely coherent again.
As I said, the actual colonoscopy was the easy part. The build-up was the sucky part.
Are You Due for a Colonoscopy?
Let me know in the comments if you need to have a colonoscopy and how you are feeling about getting it. I hope I didn’t scare the bejeezus out of you!