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!

[bbarbie1]

Jewelcutt:

A couple of things, actually, occured to me on the drive home:

1. someone in ICU is likely to have many complicating issues the might preclude adequate medication, right? It should be easier (less worrisome?) to medicate someone who is in overall good health and in their 20's?

2. Demerol and Versed are standard for this area and seem to be effective for most people

3. Get a doc who is not afraid to use enough meds to achieve adequate levels of sedation

4. Is there truly a hurry to do this? Is there another facility that can deliver the type of sedation/anesthesia you feel comfortable with, and on a Saturday?

5. You might check out some of the other posts about levels of drugs used. Cecumseeker says that there is no such thing as average levels of meds, that everyone is different (hope I paraphrased him somewhat accurately! Read his post to be sure.). Certainly you should make sure the doc will be responsive to your requests for more meds if you are in a lot of pain!

Again--best wishes for a smooth, minimal-trauma, procedure!

[mshultz]

1. someone in ICU is likely to have many complicating issues the might preclude adequate medication, right? It should be easier (less worrisome?) to medicate someone who is in overall good health and in their 20's?

That's a good point. When I was in the Critical Care Unit, I was given a reduced amount of sedation for the EGD due to my condition (2mg Versed and 50 mg Demerol, plus the Cetacaine throat spray). I am 5' 7.5", and weighed about 175 pounds at the time. This amount of sedation had no perceptible effect on me. However, I found the EGD to be surprisingly tolerable.

At my request, for the first part of my colonoscopy, I was given 1mg Versed and 50mg Demerol. I asked for additional medication when the scope was going from the transverse colon to the ascending colon, and was given 2mg Versed and 25mg Demerol. Unfortunately, I was unable to remember what happened after that, but the doctor said that I fell asleep half-way through, so presumably I was no longer in pain.

Chronic use of alcohol and/or benzodiazapines (Valium, etc.) results in a tolerance to Versed, while chronic use of narcotics results in a tolerance to Demerol. As a result, these people will be more difficult to adequately medicate.

Since I am determined to get through my next colonoscopy without sedation, I spend a lot of time reading about the procedure. The more colonoscopies the doctor has done, the easier the exam. Note that studies done on the tolerability of colonoscopies are limited to doctors with extensive experience (say >2000 exams). Also, the use of abdominal pressure during the exam helps. The Olympus ScopeGuide sounds promising:

http://www.medscape.com/viewarticle/473215 (registration required but free). It can be assumed that a doctor good enough to use this technique on awake patients is going to be better with sedated patients than a doctor without such experience.

[jaimealmostRN]

I had my first colonoscopy last week (had a sigmoidoscopy 10yrs ago). While I remember saying "oww" during the actual proceedure, I don't remember the pain (thank you versed). The WORST part is the prep. I did NOT feel "clean and free" as someone described to me. I have much for empathy for my pts with excoriated backsides now!

[jewelcutt]

Hey everyone. I had to get my colonoscopy done last saturday because it had to be done this past week and I had to have it at my hospital because that's where my insurance is through. Anyways, it was great!!! Saturday mornings are very quiet and slow. I was so scared I almost cried but my doctor is the best so he took really good care of me. I ended up getting 6 of versed and 75 of demerol. he gave me the initial two of versed and 50 of demerol and asked me how if I felt anything, so I lied and said maybe a little even though I could really feel the drug. The last thing I remember saying is that there was no way I was eating a low residue diet and going straight for a cheeseburger! He laughed at me. I think I remember saying ouch but no pain or recall. I woke up in recovery after like a half an hour and threw up, got some zofran, never felt so great in my life. I slept for hours when getting home. The prep was awful. I couldn't drink even one glass of the golytely so I got fleets phospho soda from the store, found online instructions at other GI centers, and used that instead. Anyway, I think the main point to any story is that if you are very afraid, there is no reason you can't have anesthesia, and you need to communicate very well with your doctor. For those who don't want to be sedated or forget I don't quite understand the logic. I give versed all the time to prevent you having recall or nightmares about the operating room, usually people have so much stress from having to get a procedure they don't need anymore from us. We aren't barbaric, if you are in pain we will give you pain medicine. I understand no-one likes losing control but you just have to place yourself in the good hands of anesthetists, nurses, and doctors. We are really there to help you.

[CHATSDALE]

I am glad that you came thru with flying colors...maybe you gave me the strength to have mine done...i will call md monday before i chicken out ... i hope that your results were good

[mshultz]

I had my first colonoscopy last week (had a sigmoidoscopy 10yrs ago). While I remember saying "oww" during the actual proceedure, I don't remember the pain (thank you versed). The WORST part is the prep. I did NOT feel "clean and free" as someone described to me. I have much for empathy for my pts with excoriated backsides now!

The worst part for me was the restricted diet prior to the prep. NutraPrep: http://www.ezem.com/vc/nutra.asp?action=vc sounds much better than the three cans of pop that I had as my meals.

I was not "clean and free" either. In fact, the morning of the exam, I was still expelling light brown fluid. There was a lot of fluid visible during the part of the colonoscopy that I watched, as well as the occasional fecal particle. The nurse told me that the doctor would suction out the excess fluid and gas on the way out. I had no problems with flatulence or fluids in my colon when I regained awareness.

[mshultz]

For those who don't want to be sedated or forget I don't quite understand the logic. I give versed all the time to prevent you having recall or nightmares about the operating room, usually people have so much stress from having to get a procedure they don't need anymore from us. We aren't barbaric, if you are in pain we will give you pain medicine. I understand no-one likes losing control but you just have to place yourself in the good hands of anesthetists, nurses, and doctors. We are really there to help you.

The best explanation I can give for avoiding sedation and amnesia is that there is no one method that works to reduce stress for all people. From reading this forum, it is apparent that many nurses feel their medical knowledge would make their own hospital stays more stressful. As a result, patients tend to be insulated from the details as much as possible. Although well-intentioned, and quite probably best for most patients, this approach has the unfortunate effect of greatly increasing my stress. The best approach for me is to treat me like a medical or nursing student and to provide me with detailed, comprehensive written information, thereby indulging my insatiable curiosity.

According to my medical records, reducing my anxiety was part of my treatment plan while I was in the Critical Care Unit. The irony of the situation was that because I was not given any written information and had no way of taking notes (no pen or paper either), the effort of trying to remember what little information I was told, along with trying to be the perfect little patient when I was not told how to be the perfect little patient, resulted in more anxiety for me.

The challenge for me in the future will be how to convey my preferences to the medical staff without causing an adversarial relationship. The best I can think of so far is to tell them up front that I am greatly interested in the procedure, and will be requesting my complete records so that I can learn as much as possible. I can only hope they understand, and not think I do not trust them, or am looking to file a lawsuit.

As far as avoiding sedation, my response will be: "I want this procedure done without sedation, by someone who is experienced and comfortable with performing it without sedation. Can I get this here, or do I need to be referred to a teaching hospital somewhere else?"

[presC.]

hi there, good thing i found this thread, really helpful such time like this.

if your doctor informed you that you have rectal polyp along with external hemmorhoids, what are the things to be expected?

and what are the procedures needed to be done? what are the options?

i need to clarify things. we consulted a general surgeon yesterday and informed us that my dh got one. (he's 36 y.o. HX: his father died 10years ago due to colonic CA) my husband's really anxious and down about the news. he was adviced for a barrium enema. we're still at awe! help anyone?

i'm asking comments/info with you guys because i know you have many insights and experiences about this matter.

thank you.

[bbarbie1]

Why is the doc recommending a barium enema rather than a colonoscopy? BEs can be extremely uncomfortable, but you can sleep through a colonoscopy (if you want, anyway). If something is found on the BE you may have to have a colonoscopy anyway. Why not try to get everything done in one procedure? The prep is the same. Won't hurt to ask.

Good luck and best wishes!

[presC.]

thanks bbarbie1 for the info/suggestion, i'm having thoughts about it actually, and before i read this we made an appointment to an expert(specialist) doctor yesterday about my husband's condition so that "everything done in one procedure" as you said.

likewise, good health be upon you.. :)

i'll keep you guys posted, i hope you won't mind

thank you!

[PACU R/N]

:zzzzz Hi to all facing up to the 'endoscopy' experience. I also felt anxious about the procedure ie.type of anaesthesia to be used and the complications from Endoscopy. Discussed the type of anaesthesia with anaesthetist(Doctor).

She being empathic to the procedure, stated Propofol(diprivan) was the choice. I'm thankful, as the only discomfort was a deep pain along IV site in forearm. Off to sleep and woke up with very slight drowsiness. The Endoscopist was kind and suctioned the air at end of procedure. No 'nasties' were found, other than signs of reflux oesophagitis.

Lifestyle modification should take care of that. Keep well all...Cheers

[ibnrn]

I am a sedation nurse in a GI lab. I have noticed that the GI docs, who are more skilled at operating the scopes, do a better job and cause less discomfort than the SURGEONS, who also scope. We use Demerol and Versed, sometimes Fentanyl and Versed. I get so frustrated and angry:angryfire because I have seen many, many patients crying out in pain and they remember the WHOLE thing (usually surgery patients). I am not at liberty to medicate the patient as I would like to; the physician has to tell me how much medication to give. Most of them have NO earthly idea how much Versed and Demerol to use. This, along with inadequate skills in manipulating the scopes, is why so many folks have such a terrible experience with an endoscopy procedure.

I was fortunate when I had my 'scope. I think I got propofol; a nurse anesthetist did my "sedation" and I didn't remember anything about it, and woke up quickly afterwards. Also I had a GI doc. Which helps greatly.

Thank you for bringing up this very important issue!