recent colonoscopy experience

[mat/childnurse]

I had my first colonoscopy last Friday. I am 46 and my mother has had two surgeries for colon CA, so I felt pretty good about being so responsible. I went to every website I could find and researched all aspects of the procedure (patient teaching, videos of colonoscopies, personal experiences, etc.) I also spoke to several people who had gone through the procedure recently including my husband and my OB/GYN. I felt very well informed and more than educated about what would happen, what I would see on the screen, and how it would feel.

I was given Versed 2 mg and Demerol 50 mg IVP and the doctor waited until I assured him that I was groggy. Everythiing went just as I expected until just after insertion when air was instilled into my colon. I experienced some of the worst pain I have ever felt. The doctor immediately instructed the nurse to give me "25 more" which I assumed meant more Demerol. He continued the exam with me moaning in pain. I felt every mm. of my colon being blown up and navigated. I tried to watch the screen because I was really interested to see my own colon after viewing so many others in my preparation for the procedure. The pain was practically unbearable. Since then, I have had trouble concentrating and sleeping because I keep reliving this scene. I feel so duped and betrayed. All of the instructions and testimonials I read stated that there is little dicomfort and the Versed gives the patient amnesia to any discomfort that may occur. I have lamazed three children and had I known ahead of time, I would have gotten into a breathing pattern and anticipated the pain. I will know better next time. And as a nurse, I will return in 5 years because of my FH.

I guess what I want from you guys is some validation that indeed this does occur occasionally and that I'm not alone in this experience.

Thanks for your input. Sorry about the length of this, but I needed to vent!

[beyondword]

I am not a nurse but I think this forum would be the best chance I have of solving my dilemma.

I had my first colonoscopy 5 years ago. The doctor told me I would be sedated, that I'd "know what was happening but not care", as he put it. OK, that sounded fine to me.

It was not until I was on the table that the nurse, honest woman that she was, told me that "one of the meds in the IV" (that I now figure, having done some research, was Versed) would give me amnesia for the procedure.

I almost jumped off the table. He had not told me that!!! When he came in I confronted him. At first he started to scold the nurse for telling me. Then he tried to say that he HAD told me, that he'd said it would be like taking Valium. Well, that was news to me, that Valium has an amnesiac effect.

He finally said he'd give me only a little of the Versed. I agreed (I didn't have too many options at that point, really). I remember the start of the procedure; I saw the inside of my colon on the screen. I also remember saying "ow" a few times, but not being in real agony, just some discomfort. I suspect he upped the Versed at that point because I recall nothing after that.

When I woke up he asked me "You remember it, don't you?" and I said yes, mostly to get rid of him.

I swore I'd never go back to this man. So now it's time for the next one, and my doctor seems honest, reasonable and accommodating. He also doesn't seem to want to hurt me (nice man).

He told me there are 3 options:

Propofil (sp?), which will put me to sleep.

Versed + painkiller, which will leave me conscious but give me amnesia.

Painkiller alone, which might or might not be enough to make the procedure tolerable.

Versed is NOT an option. I will not voluntarily suffer amnesia again. Propofil is an option, because if I'm asleep while it's happening, I have no need to remember it. It's being awake, aware, and possibly in pain during the procedure and not being allowed to remember it that I can't accept.

He suggested I go with the Propofil this time, and if he sees that my colon isn't too twisted or kinky, then I go with just painkiller for the next time.

Now, the problem is this. Versed vs. propofil depends on where the procedure is done. And the day of the week depends on where the procedure is done. Long story short, my schedule is such that if I go to the place where I can have the Propofil, I can't get it done for several months. But if I go to the other place, I can have this over with in a few weeks. And I want to get it over with.

So. Any opinions? Does the fact that I remember some of the first time, and it wasn't too painful, suggest that I'll manage OK with just the painkiller? Or does the fact that I said "ow" suggest that it will hurt? I'd say I have at least an average tolerance for pain, having had 2 babies without pain meds. But I've never had a broken bone or major surgery, so I don't know how I'd react to severe sustained pain. I tend to grin and bear it when I slam my finger in a drawer but I doubt that's comparable ... Oh, and the reason I had this done in the first place was that my sister had colon cancer (she's fine now, thanks) - and she said the doctors found that HER colon turns in an unusual way - maybe that means mine's not too straight either, so it will hurt more?

Thanks in advance.

Barb

[bbarbie1]

I am not a nurse but I think this forum would be the best chance I have of solving my dilemma.

I had my first colonoscopy 5 years ago. The doctor told me I would be sedated, that I'd "know what was happening but not care", as he put it. OK, that sounded fine to me.

It was not until I was on the table that the nurse, honest woman that she was, told me that "one of the meds in the IV" (that I now figure, having done some research, was Versed) would give me amnesia for the procedure.

I almost jumped off the table. He had not told me that!!! When he came in I confronted him. At first he started to scold the nurse for telling me. Then he tried to say that he HAD told me, that he'd said it would be like taking Valium. Well, that was news to me, that Valium has an amnesiac effect.

He finally said he'd give me only a little of the Versed. I agreed (I didn't have too many options at that point, really). I remember the start of the procedure; I saw the inside of my colon on the screen. I also remember saying "ow" a few times, but not being in real agony, just some discomfort. I suspect he upped the Versed at that point because I recall nothing after that.

When I woke up he asked me "You remember it, don't you?" and I said yes, mostly to get rid of him.

I swore I'd never go back to this man. So now it's time for the next one, and my doctor seems honest, reasonable and accommodating. He also doesn't seem to want to hurt me (nice man).

He told me there are 3 options:

Propofil (sp?), which will put me to sleep.

Versed + painkiller, which will leave me conscious but give me amnesia.

Painkiller alone, which might or might not be enough to make the procedure tolerable.

Versed is NOT an option. I will not voluntarily suffer amnesia again. Propofil is an option, because if I'm asleep while it's happening, I have no need to remember it. It's being awake, aware, and possibly in pain during the procedure and not being allowed to remember it that I can't accept.

He suggested I go with the Propofil this time, and if he sees that my colon isn't too twisted or kinky, then I go with just painkiller for the next time.

Now, the problem is this. Versed vs. propofil depends on where the procedure is done. And the day of the week depends on where the procedure is done. Long story short, my schedule is such that if I go to the place where I can have the Propofil, I can't get it done for several months. But if I go to the other place, I can have this over with in a few weeks. And I want to get it over with.

So. Any opinions? Does the fact that I remember some of the first time, and it wasn't too painful, suggest that I'll manage OK with just the painkiller? Or does the fact that I said "ow" suggest that it will hurt? I'd say I have at least an average tolerance for pain, having had 2 babies without pain meds. But I've never had a broken bone or major surgery, so I don't know how I'd react to severe sustained pain. I tend to grin and bear it when I slam my finger in a drawer but I doubt that's comparable ... Oh, and the reason I had this done in the first place was that my sister had colon cancer (she's fine now, thanks) - and she said the doctors found that HER colon turns in an unusual way - maybe that means mine's not too straight either, so it will hurt more?

Thanks in advance.

Barb

Barb:

Sorry you had such an upsetting experience!! However, I'm proud of you for standing your ground and trying to make him understand your point of view. A good for you in changing docs. The only way, sometimes, we have of making our point is to hurt them in their wallets--take your business away. It's too bad, but often true.

I've had one C and had a pretty good consult beforehand, and that is the thing to do whenever possible, at least in my opinion. I was OK with the Versed, but wanted to make it clear that I DID NOT want to be aware of the goings-on during the procdure!!! He took me at my word. I had 100 mg of Demerol in 2 doses, and 10 mg versed (50-10-50). The second dose of Demerol did exactly what I want. However, the Versed did not grant complete amnesia--I remember what we talked about before I went to "sleep", and I also remember rousing a bit twice and groaning, but going immediately back to sleep. I do not remember it at painful, just a sensation. This was fine for me and I would do it again.

I have read several very positive things about the Propofol. My own doctor, who I like and trust, told me that in my state the GI docs are trying to get the regulatory stiffs to let them use another drug, that would be used alone, and I think he was referring to Proprol. That means he thinks it is a good drug. I would try it next time if it were offered, but I would also be OK with the combo we used the first time. I guess, for me, the amnesia is not a big issue, but certainly, you are the one undergoing the procedure, and you need to decide what you are comfortable with.

Is this a routine exam? Would it hurt to wait the few months to get the Propofol procedure? For me, I get so anxious (it's my little phobia, this procedure--I think it's disgusting and humiliating, and would want to get it over with ASAP, but that's just me, and my issue to deal with) that waiting would be worse than anything else, but if you're OK with waiting, why not try for it? Your first procedure wasn't that satisfactory, so you don't really have much to lose, and you might gain a much more "pleasing" outcome. Or, state to the doctor that you don't want to be aware, and maybe they can up the dose of Demerol to increase the pain threshold. I think I would have been OK without the Versed. Sometimes the Versed is a security blanket for the docs, I think--since they don't know ahead of time what the anatomy of the colon is, they want to patient to forget if there's more pain than they anticipate. My demerol was 100 mg but everyone's different, and I'm not a small person--5'11" and 170. My doc also said he could give me more if I asked for it, so apparently I was not at the max yet. I'm not a nurse either, so I don't know these values from a professional standpoint, please understand!

I hope this helps. Try to get enough info ahead of time that you are comfortable--gut feelings are important. Be careful reading messages boards and other posts, though--sometimes they can be really scary!! But you've done it once, and know what your issues are, so you're much better off!! When you're done, make sure you let us know how it went--best wishes, good luck, and God be with you!

[MattLloyd]

I am an auxiliary nurse and work in the endoscopy department at a acute NHS hospital in the UK. If you could wait for the propofol that might be the best idea. I am not a trained nurse, and we use different drug names over here in the UK. All I can say is that the procedure may not always be painful, but can be very uncomfortable - especially when trying to get the scope around some tight bends within the colon. Personally, if I were having a colonoscopy, I would rather be sedated and not able to remember the procedure - especially when you hear the comments and language some of the doctors use when having problems progressing further into the colon with the scope.

If it is just a routine examination, it may be better to wait for the few months and go somewhere else.

I hope this helps.

[beyondword]

Bbarbie and Matt: thank you so much for your responses. I have rethought this whole thing and, following a suggestion you both made, have rescheduled for the clinic that offers the Propofol. I don't like being "out", but it's infinitely preferable to being awake and aware and then forgetting what happened. I understand absolutely that not everyone feels this way but it's how I feel.

One thing that I have to say. Five years ago when I had my first colonoscopy and all those unsettling and upsetting things happened with the Versed and the doctor -- I tried to vent to my friends and family, tried to convey how angry I was. And I got blank looks and comments like "Oh, don't worry about it" and "Why would you want to REMEMBER that?" So I quickly learned to just keep my mouth shut. And I haven't told a soul since. It took a lot of nerve to bring it up again, and I think the only reason I did was that I would be anonymous and not have to face those blank looks and hear those condescending tones... And so I posted, and got such wonderful understanding and support! Thank you so much.

Barb

[beyondword]

Bbarbie and Matt: thank you so much for your responses. I have rethought this whole thing and, following a suggestion you both made, have rescheduled for the clinic that offers the Propofol. I don't like being "out", but it's infinitely preferable to being awake and aware and then forgetting what happened. I understand absolutely that not everyone feels this way but it's how I feel.

One thing that I have to say. Five years ago when I had my first colonoscopy and all those unsettling and upsetting things happened with the Versed and the doctor -- I tried to vent to my friends and family, tried to convey how angry I was. And I got blank looks and comments like "Oh, don't worry about it" and "Why would you want to REMEMBER that?" So I quickly learned to just keep my mouth shut. And I haven't told a soul since. It took a lot of nerve to bring it up again, and I think the only reason I did was that I would be anonymous and not have to face those blank looks and hear those condescending tones... And so I posted, and got such wonderful understanding and support! Thank you so much.

Barb

[PACU R/N]

Hi bbarbie1, I'm in that boat too. Having a gastroscopy and colonoscopy on the same day soon. With Midazolam and fentanyl IV. Yes I'm a little anxious, the midazolam should take care of that. Reason - low HB, occult blood found in bowel motions. Had a virtual colonoscopy done(Usual bowel prep, rectal tube inserted, air blown into large bowel, and a CT scan performed.) Some moderate cramping felt, could've had buscopan. But held out, as I knew this procedure wouldn't last long. The clinic made a CD of the scan. No abnormalities seen.

So Dr referred me to a GIT specialist to have a gastroscopy done, as she stated that the bleeding must be higher up. Specialist still wishes to do the traditional colonoscopy as well. He said that all aged 50yrs and again at 60yrs should have this check-up.

I can say after the number of older ones having partial or total colectomies because of tumours found, has frightened me. I work in Op Suite. I am trying to avoid major surgery, and live 'til I'm 80yrs. Just reminds me, on colonoscopy, no bowel perforations please:bluecry1: Will keep you posted. Hope all went well. Cheers

[PACU R/N]

Hi bbarbie1, I'm in that boat too. Having a gastroscopy and colonoscopy on the same day soon. With Midazolam and fentanyl IV. Yes I'm a little anxious, the midazolam should take care of that. Reason - low HB, occult blood found in bowel motions. Had a virtual colonoscopy done(Usual bowel prep, rectal tube inserted, air blown into large bowel, and a CT scan performed.) Some moderate cramping felt, could've had buscopan. But held out, as I knew this procedure wouldn't last long. The clinic made a CD of the scan. No abnormalities seen.

So Dr referred me to a GIT specialist to have a gastroscopy done, as she stated that the bleeding must be higher up. Specialist still wishes to do the traditional colonoscopy as well. He said that all aged 50yrs and again at 60yrs should have this check-up.

I can say after the number of older ones having partial or total colectomies because of tumours found, has frightened me. I work in Op Suite. I am trying to avoid major surgery, and live 'til I'm 80yrs. Just reminds me, on colonoscopy, no bowel perforations please:bluecry1: Will keep you posted. Hope all went well. Cheers

[bbarbie1]

Barb:

"Don't worry about it" must be the most useless phrase in the English language. How you feel is just that--how you feel, and no one else can tell you what your feelings should be. My sister is a good listener, which I needed after my experiences with the flex sig and colonoscopy. Hers is next year, so we'll trade roles, I guess!

In any case--sounds like you have a plan!! I hope it goes well for you--maybe you can go on the 10-yr plan if they don't find anything? That would be great! Write back after it's over and let us know how it went. If it works well for you, maybe next time I'll opt for the Propofol (even though I may have to drive to another state!). Take care. Frankly, it would be worth it.

Bbarbie1

[Energizer Bunny]

Well...now that I am having to have a colonoscopy, this thread is probably the best place to go. I have my consult with my GI dr. next week but until then would like to know if most docs give the option of being put to sleep or just given pain meds? I do not have a very high tolerance for pain and was sexually abused in the past (in the rectum) so it is very difficult for me to endure these procedures.

[Energizer Bunny]

I should probably tell you all that I had a sigmoidoscopy with NO meds. at all back in February but it was excruciating when he had the scope all the way in.

[bbarbie1]

I guess that's how all flex sigs are done (no drugs), although mine was awful, too. No one I've ever spoken to would repeat one, that's how painful they are, not to mention I found it totally humiliating. Somewhere along the line, "mild discomfort or cramps" has come to be substituted for "white knuckle pain", and does a great disservice to all potential patients. A colonoscopy is much better--they see the whole colon, and you can be drowsy-to-sleeping the whole time. And the repeat time is less often!

It is my understanding that unless general anesthesia is used, you are not technically "asleep". It is conscious sedation, achieved with good doses of pain killer such as demerol, that is most often used unless there are anatomical problems that make even c.s. unfeasible. With c.s. there is a gradient of levels possible, from drowsy to what was for me a nap. The patient can rouse for verbal commands, though. I requested/demanded that I not be aware for the colonoscopy. I had no desire to be aware to any degree(!!) of having that thing shoved up my behind, and was concerned about the pain as well, and would not have used any doctor that wouldn't agree to that level of sedation. My doc was very good and very understanding, and I remember almost nothing. Many people aren't that worried/concerned or whatever, and ask to be awake enough to watch the screen. You need to decide what is right for you, and demand it. You should absolutely make clear in your consult the level of awareness/pain control you want or don't want during the procedure. If the doctor resists your requests or seems uncomfortable, get a new one. I had 100 mg of demerol, which "put me out", and I was told ahead of time that I could ask for more drugs if I was in pain. I would go back to that guy!

Some people resist the Versed given with the demerol, which induces anmesia. I don't like the idea of it much, because then you could be in terrible pain during the procedure and not remember it. That possiblity really disturbs me. I think the docs use it because they can't always anticipate the colon anatomy, and pain results from trying to get the scope around the corners. I will probably go without it next time.

Good luck!! Write back and let us know how it goes!

B

[Energizer Bunny]

Thank you for all the information. It will really help when I go in for my consult next week. I was okay with the sigmoid. until he got to the very end and then I almost lost it. I will check back in after the consult and let you know what he said as far as meds.