recent colonoscopy experience - page 11

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... Read More

  1. by   CrohnieToo
    As a Crohn's patient (in the small intestine, not the colon) who has had several colonoscopies (in the US) w/o sedation and just some Demerol for any discomfort at my insistence I can attest that a colonoscopy w/o sedation does NOT need to be painful.

    So VERY MUCH of the discomfort experienced during a colonoscopy is the DIRECT result of the scopist's lack of skill (I don't care how many they've done, if they are rushed to get thru a lot of scopes each procedure day they are NOT developing skill). Skill requires care and concern for the patient, it takes patience to use less air and to recognize and pull back the scope when the shaft loops and stretches the colon. And that requires more time. The PRIMARY cause of pain during a colonoscopy is the scope shaft looping back on itself, followed by excessive air as the next.

    I've posted the URLs before for the medical abstract (I have the full article) that documents this.

    Endoscopy 2002 Jun;34(6):435-40

    Patient pain during colonoscopy: an analysis using real-time magnetic
    endoscope imaging.

    PMID: 12048623 [PubMed - indexed for MEDLINE]

    In addition, Glucagon has been used (with mixed results) to reduce colon muscle spasms during colonoscopy. My gastro used it once for my first colonoscopy. I don't have the URLs or the articles regarding this handy.
  2. by   crazy4trauma
    While I certainly can't advise you, I can share my own experiences. The use of propofol has been heavily discussed in this thread already, you would probably get a lot of good info reading the entire thread. However, I have had both, and I think I did better with propofol. I have absolutely no recollection of the procedure at all. I have vague memories of my others with versed, not bad memories, just bits and peices. Last week after my scope I asked the Dr. a few day later to repeat what she had toild me because I had forgotten most of it, and she said that is interesting because I was wide awake the entire time. I barely remember it. I have a pretty high tolerance to narcs, and I had 8.5 of versed and 150 of Demerol and was still awake, so knowing that I prefer the propofol.
  3. by   GIRN
    Unfortunately, you must have a "torturous colon" That's a colon that's hard to navigate. For most people like myself, Versed and Fentanyl is all you need to get through it. I wanted to watch, like you, so I asked for light sedation and just when I was ready to cry uncle and ask for more was over. However, some people have a more difficult time and need a lot more medication and you don't know who they are till you're in their colon and see their reaction.

    I'm an Endo nurse and I've been the nurse pushing the drugs when the occasional patient is crying in pain. Luckily, our hospital switched over to using Anesthesia to push Propofol for scopes and our patients are much more comfortable. When you go back for your next scope you should either ask your doctor to schedule it with propofol or find another provider that will do so. There's no reason to have anyone experience pain during a colonoscopy. As far as the redhead's amazing how many redheads have adverse reactions to anesthesia.
  4. by   trepinCT
    All very interesting stories and everyone has different experiences..after alot of research (including this post) I had my colonoscopy done last november and requested nothing for pain or sedation( nosey future RN) I wanted to see as much of the procedure as possible. I had a wonderful Dr. and nurses in an outpatient GI facility. we had an agreement to do as much of the procedure as I could tolerate(sigmoids are done with no sedatives, so we figured we could at least get that far)..I know that they like sedation b/c they can get done faster, but I agreed to not be a superhero and would cry uncle when I was ready for Propafol...It started out OK, but by the time he was ready to go into the transvers colon, I took the med. It felt like labor pain on a 5 scale for me...wouldm do it taht way again, but would never want to take anything that would cause amnesia..I am a control freak too..either keep me awake or completely knock me out..none of that amnesia crap....
  5. by   Clem52
    Flex sigs may be done without sedation, but they should be. No one will ever do another one (sig) on me without knocking me out. I thought it was the most ungodly painful thing I have ever done, excepting childbirth. Having had one of those, I asked/demanded to be completely out for a colonoscopy, and just can't imaging how the whole colon could be tolerable without major sedation. I know the skill of the doc makes a lot of difference, this guy must have been trained by the 3 Stooges. I won't ever get sucked in by "it doesn't hurt" ever again.
  6. by   mshultz
    Quote from Clem52
    Flex sigs may be done without sedation, but they should be. No one will ever do another one (sig) on me without knocking me out. I thought it was the most ungodly painful thing I have ever done, excepting childbirth. Having had one of those, I asked/demanded to be completely out for a colonoscopy, and just can't imaging how the whole colon could be tolerable without major sedation. I know the skill of the doc makes a lot of difference, this guy must have been trained by the 3 Stooges. I won't ever get sucked in by "it doesn't hurt" ever again.
    Thanks for telling us about your experience. My attempt at a colonoscopy with reduced sedation is on page 3 of this thread. As the scope was advanced through my sigmoid colon, the pain caused my face to break out in a heavy sweat; something I had never experienced before.

    Since this experience, I had been wondering about sigmoidoscopies done without sedation. Assuming my pain tolerance is as good as anyone else's, don't people find this to be extremely painful? Apparently, yes they do.

    One of my instructors told us about her sigmoidoscopy. She was given Versed (I assume no narcotic since she did not mention it). Her quote: "I thought I was going to die". She said that she wants to be "out" if she has another one. She did not say the pain would not have mattered if she had not remembered it.

    It would seem that I am not the only person who believes that being in pain but unable to remember it is not adequate pain control. However, my belief that bad memories are much better than no memories at all probably puts me toward the extreme end of the scale with regard to the use of amnesiacs.
  7. by   linzz
    I watched a colonoscopy during nursing school and the lady was in pain. It was a shock to me because I thought that this was not a painful procedure, so after seeing one, I no longer believed it. Now after reading this thread, my eyes have really been opened up. If I had to have one, I would have to insist on general sedation as demerol makes me very ill and although I have had two kids, a colonoscopy just terrifies me. So to anyone who has had one, you are really brave.
    Last edit by linzz on Jul 12, '07 : Reason: grammar
  8. by   talondora1
    Wow! I am so sorry you had to experience that. My mom died from colon cancer. She had her tests every year after age 50 and nothing showed up until a year before her death. By then it was too late. She had no symptoms if you can believe it.

    She never mentioned having pain though after her tests. I wonder if perhaps a different pain med would have been more appropriate?

    In any case, I wish you well, Hon. God bless and protect you.
  9. by   ICU_floater
    jewelcutt- wanted to say thanks, having my first upper and lower tomorrow. As an ICU nurse, I've watched and seen easy exams and some horrific ones where I'm begging the doc to push more meds... even stating "I don't think we should continue until the patient is more comfortable", and even "no I won't hold the patient down, thats what the meds you won't order are for!"

    So I'm quite afraid not to have someone to speak up if I'm too groggy but in pain to do it myself. I know and love my GI doc, yes I trust him, but the fear remains as it will. I plan to beg the nurses ahead of time to snow me until oblivion, they can always bag me for a bit until the meds wear off I want down and out!!!!! I don't CARE what my colon looks like. thanks again

    Quote from 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.
  10. by   ICU_floater
    the propofol without an experienced nurse IS dangerous, it can rapidly drop heart rate and blood pressure plus you never know how someone will respond and it can depress respirations to the point of not breathing in moments. Propofol is an EXCELLENT rapid acting drug that does cause amnesia and does NOT treat pain. Additional drugs are used like fentanyl for pain. Our area has outlawed demerol due to the nasty side effects and fentanyl is used.

    I don't think any GI who does scopes in their office use propofol, this really should be CRNA, or done in the hospital with an ICU criteria ACLS nurse whos SOLE job is conscious sedation, not assisting the doc. Versed and fentanyl are a great combo too, versed is just longer acting than propofol and needs small increment increases for comfort when done in an outpatient type setting. If you wake and are aware, you're not down enough... don't just put up with it, say you're uncomfortable.

    My 0.02, with my experience in administering, but tomorrow I'm on the other end of things, so it remains scary to me:uhoh21: and no, no propofol available... but as I previously posted, I'm begging for syringes generously emptied into my IV.

    Quote from spaniel
    Thank you for the post- I too am up for a colonoscopy but I am too concerned about having Propofol without anesthesia backup. (there was a huge debate on this in the Propofol section.) I'd worked many years ICU/CCU and the CRNA's do seem to know what they are talking about. Any other advice regarding the feasability and safety of having Propofol WITH a seasoned CRNA/anesthesiologist right near the bed? I am really wondering if even that is safe if not done in the proper setting/backup.
    While I'm at it, what are some of the higher doses of Versed/Demerol used? I know my prior doses were 50 mg. Demerol and once 3 mg. of Versed and I believe another time 5 mg. of Versed. Didn't do the trick> I too have a torturous bowel , and I have endometiorsis with adhesions.
    I've wondered and researched the Virtual Colonoscopy as well- anyone know if the pain is significantly less with this?
  11. by   ICU_floater
    Quote from bbarbie1
    If the doc did not allow me to be sedated before he starts, I would cancel. Why would he/she want an anxious, tense patient? That certains does not bode well for a smooth procedure. Such a doctor must have his own interests well before those of the patient. I'm tired of docs with the God complex that don't treat patients with respect. I want to be so sedated that not bearing down is not something I even have to consider.
    I agree, and I think you're looking at this out of context. Meds cannot be administered until the doc is present and ready to go. This does NOT mean he will start before you are comfortable. trust me here, as a NURSE, not a tech, (no offense intended), that he will not advance the scope until the meds kick in... you just can't have "hits" of versed in some waiting room prior without proper monitoring to dispel anxiety.
  12. by   ICU_floater
    Quote from RN2Bn2006
    Well the 1st time was unexpected, so we discussed plan for heavier meds next time - but because my BP dropped 2nd time (during procedure) they could not give me anymore. To be honest, what exactly are they supposed to do? The procedure has to be done, what happens if they stop in the middle of it? They could not increase my pain meds due to bp -- I've already had the prep - and I SURE ain't going do to that again any time soon, so It was just a matter of trying to comfort me until it was over. Fast forward to last month........... I had my 3rd scope, and after talking with (same) doc, we decided on propofol (sp?) and it worked out wonderfully! I was out like a light, only slightly became aware once during procedure, and it was just like for 2 seconds, and I was back out. Woke up with no groggy hang-over. So to me - this is the ONLY way to go. I do not know why demerol/versed works for some and not for others. All I know is I have found the way that works for me, and I'm sticking to it.
    I feel like we should have done the propofol the 2nd time, and would have saved myself a bad experience.
    They were supposed to do a fluid push to raise your bp to sedate you, YES, they were to stop, PAIN is the 6th vital sign and pain is an unacceptable response to diagnosis and treatment. They were to stop, give you fluids, then meds then schedule you under anesthesia..... like you had with diprovan/propofol. THAT is what a good doc does and should do. I never would have gone back.... but at least NOW you know what works and NEVER settle for less. The nurse there to care for you needed to speak up.... that whole group IMHO is lacking.... twice is a crime.
  13. by   CrohnieToo
    Quote from momedsurglpn
    Please ask for diprivan for sedation. It burns like wildfire going in but the instant it hits your out. Personal experience talking. I awoke and felt like I had taken the best nap of my life. Was not groggy or anything. No discomfort whatsoever and I had a polyp removed too. Now, if they can just figure out what to do with the nasty prep more people would have it done. I'm sorry for your suffering needlessly.
    Diprivan should NOT burn when administered. IF it does it was administered improperly and not diluted enough. That burning can cause not just superficial thrombophlebitis but on rare occasion even an actual blood clot and possible pulmonary embolism. (It happened to me. No PE, but a blood clot in the axiallary vein as well as the STP due to improperly diluted and administered Toradol).

    I had Diprivan once and you are right, it is WONDERFUL, out like a light and bright-eyed and bushy-tailed in no time at all.