I see my Gastro tomorrow and will be talking about scheduling my colonoscopy. I don’t think it as a “surgery” as they are just looking at the colon but if there are polyps, they would be removed. Should I stop dosing? If so how long before? (I am on 8mg/wk). Also, if one stops dosing for some reason, can you go resart at your normal dose or do you need to ramp up again? (for me that would be another long 8 wks)…
Obviously this would be pretty minor surgery, but my approach is to err on the side of safety and pause the rapamycin in situations like this. I’ve ramped back up to my regular dose quickly (over two weeks - e.g. 4mg one week, then back up to 6 or 8 weeks the following), but different people may respond differently to this type of ramp.
See past discussion threads on similar situations:
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Not surgery unless you get perforation and then you are up the $hit creek. yeah, def stop the Rapa (unless prescribed by a physician for specific disorder).
Okay - Cannot give any individual medical advice on this board … BUT I’ll lay out my rationale and you can choose what to do.
Occasionally colonoscopy leads to bowel perforation, which is a surgical emergency, and I see this a couple of times yearly when working in the ER. So being suppressed on healing and immunity if this were to occur, would be bad.
Next issue, colonoscopy often results in finding polyps and having those removed as part of the procedure. So this is effectively a minor surgical procedure - and your body would need to heal from this - having impaired healing wouldn’t be good.
If I were in your shoes, I’d need to know what was done in the colonoscopy, as I’d tend to wait at least 7-10 days after if polyps were removed or biopsies done - but if nothing done - then if no abdominal pain, no fever within a few days - I’d personally not be reluctant to take my next rapamycin. But that is me … and my rationale.
You can talk with your GI about this - but I’d certainly not be taking rapamycin in the 3-4 days prior to going in for this if I was in your situation.
Additionally, holding a dose for 10 days, wouldn’t have me go back to my starting dose - personally, I’d pickup with my usual dose. If I came off for a month … then sure I might start 2 mg/week lower … if for 2 months, might wean back up. Just my random opinion on this … nothing I have evidence for, but that would be my usual advice and approach.
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I agree with @DrFraser I just had a colonoscopy a couple weeks ago, and I had a couple polyps removed. One was medium in size and there was quite a bit of bleeding. It took about 10 days to feel normal (I had intestinal pain afterwards. Probably due to the colon being inflated during the procedure.) Both polyps were in the rectum as were most of the ones removed previously. The pain I experienced was not in the rectum.
I stopped Rapamycin 2 weeks before and I just restarted taking it this past weekend 2 weeks after the colonoscopy. I didn’t need to ramp up and just jumped back in where I left off at 14 mg eq. (4 mg + GFJ). There were no side-effects except general well-being.
My biggest worry right now is whether the polyps were tubular adenomas (pre-cancerous). I’m also a tad worried that one was medium-sized. They had always been small before. Do polyps regrow aggressively once removed?
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The usual protocol is a shorter term follow-up if polyps are found. If no cancer found - generally, the recommendation is ~5 years for repeat colonoscopy, although I see some GI doctors being more aggressive than this.
What I’d point out for low risk individuals, is that Cologuard is a sensible option, and there is no evidence that colonoscopy improves outcomes or diagnosis.
I see a lot of low risk individuals get more invasive testing than they need. However, if higher risk, then consider pros and cons. This study if food for thought … same issue comes up with mammograms …
https://www.nejm.org/doi/full/10.1056/NEJMoa2208375
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I have always had 3-4 small polyps found during my colonoscopy’s. I had started them at around 40 yrs old as I was a military pilot and got anemia out of the blue which was found on my Flt. Pyhsical… After the normal protocol, (iron pills etc.) and the anemia persisted, I had a colonoscopy and an EGD at the same time. that’s when my poylps were found. My Dr. had me repeat every 3 yrs. Then he retired 4 yrs ago and my new Dr wanted to go to 5 yrs. We decided on 4 yrs as a compromise… Tomorrow I’ll see if he keeps his word. he’s backtracked on me a number of times on other things and I really don’t like that. If he does back track; I’m goiing to another gastro. I’ll stop dosing a week out to be safe. (assuming he keeps his word on the colonoscopy).
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I’ve found 3 years to be the best. This time I waited 3.5 years and one of the polyps was medium in size. I’d prefer to get them when they’re small. So back to every 3 years for me.