Colonoscopy questions

Published Apr 20, 2018

1 Post

I have several questions and hope you GI nurses don't mind answering them for me. I have Crohn's disease so have to get colonoscopies frequently. Before I moved to this area to take an administrative position in Ob/Gyn, I was seeing a GI doc in my multi specialty practice who is also a dear friend. When I had my colonoscopies in our hospital there, I had Versed and Demerol and would surface during these procedures. (I really wanted no sedation but my Gi doc refused saying women have more acute angles, he did not want me to have pain or any memory of the procedure even though I had 2 babies -one weighing 10 lbs with no meds at all! and he would never do a colon without sedation.) Before he gave me the meds, the endoscopy nurse would have me turn onto my left side--nothing unusual and I would bend my knees, draw them up but keeping them together. When I would surface, I would sometimes see I was on my back but usually on my side but still covered with the blanket. When I moved here and had to go to an academic medical center, several things happened that I would like to clarify. Four years ago when I had my first colonoscopy here, the tech became very irritated that I was not positioning my legs the way she wanted so she grabbed them, tersely telling me not to help her, kept my left leg straight and put my right leg way over my left leg at a right angle in an almost modified Sims position. I was shocked! Then I felt cold (understand I was getting an endoscopy first) and felt and realized my bottom was exposed and cold with entire vulva exposed straight on in the OPEN doorway so that anyone walking by could see me. Only my left leg was covered. I tried to cover myself but she yelled at me to not cover up and then an anesthesia tech walked in and HE was talking to her with me completely exposed. The endoscopy was to be done first so I was needlessly exposed. Oh and the Gi dictated my endoscopy note right after so there was plenty of time to uncover me for the colonoscopy -I had propofol and it had not been been infused yet so I was very aware!. The end of the stretcher was only about 6 feet from the open doorway. It was awful and as an OB/Gyn I knew this was a gross departure from the standard of care. I thought that position was an aberration so this time ( a few weeks ago) when I had my surveillance colonoscopy (delayed by a year because I was so fearful of being exposed and yelled at again), I just turned on my left side like in the past and drew my knees up together. The nurse was wonderful assuring me that she was going to cover me right back up until the start of the procedure and that the door would be closed. Also I was in a therapeutic endoscopy room well away from the door with multiple equipment obscuring any view. So different than before! No one made me be in that modified Sims position. In fact, nothing was said about how I positioned myself. Well my husband just had another colonoscopy a last week (he has adenomatous polyps and this was his 3rd procedure there) and told me he always has been instructed to place his right leg WAY over his left such that it is at a high right angle with the left eg straight. just like the tech had placed me 4 years prior. After I got home, I had a good size bruise on my right inner thigh so think they just positioned me into that almost modified Sims position after I was sedated (I did write a letter to the nurse manger at the time explaining my harsh treatment and met with her.)My GI told me they were making changes after my letter. ) So I think that is the way they position their patients and did not want to upset me so changed me after propofol induction. Is this a normal colonoscopy position? I had not experienced that before moving here and MD teaching videos do not show this. Also in doing abdominal compressions or position change, I really do not think they cover the patient back up as I experienced in the past. They always untie the bottom tie of the gown(never had that happen until moving here) and make sure to pull the bottom flap to the other side of the stretcher making sure it is not under the patient. They all check that-- the nurses and CRNA. (I made really sure to to tie it really tight this time given that I thought leaving it untied led to my horrible exposure before but the CRNA untied it before we went back to the procedure room. ) With the fast through -put in endoscopy I think given they all check to make sure that tie is undone and the flap is pulled to the other side of the stretcher that it is pulled up during the procedure. With position change and abdominal compressions I really wonder if the blanket is used to re-cover the patient given all this attention to the gown flap being pulled away the gown . I think they are not likely to recover with the blanket so think the gown is really up above where they need to do abdominal compressions. I cannot control that but it is different that what I experienced before. her every time I surfaced, I was covered. Another question I have is that when patient are supine, how does the GI keep the scope from dragging on the stretcher? I was so lucky before I moved here because my really good RN friend who worked in endoscopy was with me for all of my procedures there and would tell me what happened. Now in viewing videos, I think colonoscopy looks really aggressive. I ask you about this as I have BEGGED for no sedation but my former GI and my new GI (who has to take bioses every 10 cm to rule out dysplasia) have been unwilling to do that. My current GI is nationally known and says that the first time she met me because I am a relatively little woman that I would be a nightmare to scope and she told me that after my first scope--no prior surgery except for R inguinal hernia repair and no gyn problems--normal lady partsl deliveries. She said she always has propofol for her scopes and always recommends it for me. There is no way she will scope me unseated either. A couple of other questions--can patients make any kind of verbal expression of pain with propofol? The anesthesiologist that my husband last week said that they look for a leg moving or a grimace or a foot moving to know the patient is uncomfortable and then give them more propofol. As an Ob/Gyn I have done many procedures under MAC which is fentanyl, propofol, and Versed but have no experience who my patients only sedated with propofol. I told my prior GI that I do not mind the procedure, just only with my cognition affected, I am petrified I could moan or otherwise express pain and I am very stoic and no one can tell that I am in significant pain when I have all of my cognitive abilities and I really do not want to be in a situation of expressing pain. He ultimately learned that despite significant pain, it is not obvious to anyone as I was very ill for many months--never missed a day of work though! One last question, I see in videos that you have your hands holding the head in endoscopy or feet in colonoscopy. Is the to prevent moment or to provide comfort?

Thanks for your expertise.