I have to undergo a colonoscopy and know from past experience (pre-MG) that I'm not allowed to eat for roughly 24 hours while I do my GI prep, and I'm also not allowed to eat for a bunch of hours pre-procedure because of the anesthesia requirements.

When I take Mestinon on an empty stomach, I get severe (I mean SEVERE) cramping.

How have any of you handled this? Any advice?

Thanks,
Peter

Good question!

Have you discussed with neuro or gastroenterologist?

Important to figure this out with your medical team so you have no issues with weakness. My understanding is they use some drugs for the 'twight anesthesia' that can make MG patients weaker. So no Mestinon and 'twilight sleep' could put you at risk if your medical (esp anesthesia) guys are not aware of your MG status at time of surgery.

Sue

Hi Sue

Two points

First, doing without Mestinon is not an option for me for 12-16 hours, so I have to find out how to take it on an empty stomach.

Second, you make a great point about the anesthesia, but it goes even further. If something goes wrong under twilight, the anesthesiologist would need to intubate me to protect my airway; any food in the stomach would raise a risk of aspiration, pneumonia, you know the rest.

So, I'm plugging along hoping that someone has the solution. I find it odd that neither my neurologist nor gastro have ever come across this problem.

Peter

Possibly try asking a pharmacist, especially the one who fills your Mestinon (others might hesitate to advise you since you aren't really their patient), but they might just say ask your anesthesiologist or other docs.

Seems like most drugs that would help the cramping are going to work against the mestinon. I'm thinking it would have to be something that stayed localized in your stomach. So I'm thinking maybe you can't stop the cramping, but you could do stuff to feel better like take pain meds / relaxants? If those meds don't cause you problems.

Peter, When is the colonoscopy scheduled for? Is it urgent or can it wait for a few days?

You could try Mestinon syrup to see if that helps. Your doc could write a script for a trial bottle of it.

It's hard to solve a problem without knowing what is causing it in the first place. Since it's possible that Mestinon is increasing the stomach acid for you, you could try an acid blocker (once) to see if that helps. I wouldn't do anything without consulting with your primary doctor and/or your neuro though.

Stomach acid is "made" from acetylcholine, histamine and gastrin.

Are there any other circumstances under which your stomach gets upset? Or is it only the Mestinon that does it?

No offense, Wondergirl, but muscle relaxants would definitely not be a good idea in MG since they weaken the muscles. Tylenol might help but not if it's something other than a pain issue alone.

What is usually given during a colonoscopy are Propofol and either Versed or Fentanyl. I personally did fine on the drugs. I had my colonoscopy about a month and a half after my MG crisis and was not doing so well and was okay after it. Though everyone reacts differently with drugs. I was very worn out afterwards and slept for a while.

You can tell them that, if they have to intubate you, pediatric gas is a good alternative to muscle relaxers. It wears off quickly and doesn't seem to as adversely effect MG. Are you having this done in a hospital setting or a clinic?

Asking your pharmacist is a good idea, though any orders for an additional drug will have to go through your doctors anyway.

I hope it goes well and that they don't find anything wrong.

Annie

How about a glass, or half-a-glass, of just plain water...?
Maurice.

Peter - Have you tried taking something to block the side effects of Mestinon (ie, the cramping), such as glycoppyrollate or hyoscyamine? I take Hyomax-SR .375mg (hyoscyamine) 2 times a day, and have no problems with the Mestinon side effects (including the severe cramping), even if I take the Mestinon on an empty stomach (which I do on a regular basis). I do know some people who have problems even with the glycoppyrollate or hyoscyamine, so it may not work for you. But, it might be worth asking your neurologist / gastroenterologist / anesthesiologist about it.

You might also post this on the medications forum -
http://neurotalk.psychcentral.com/forum72.html

There might be more ideas on any/all meds that would need to be taken during the colonoscopy fasting prep time.

maybe a title of "colonoscopy prep & taking needed medications "??

I had the same problem with my surgery...but I had an ulcer too...I was allowed to take some tums with my meds...ask the Anastethiologist (sp)...or try to go in early and have them give u pain meds with ur mestinon until they are ready for your procedure...Good luck, let us know how it all goes for you!
Jessica

Thanks for all the suggestions and help. I've just been procrastinating until something great came along, and you folks have given me some solid stuff to pursue and evaluate. When I'm done I'll return and let you know what I did and how it worked out.

Thanks again,
poo