janjoy52

Nice to meet up with another gutsy member of a GI crew. Sounds like you know how to work "under pressure". Do keep your back safe. When all is said and done you don't want your back to be UNdone! Take care cecumseeker! janjoy52

I've been doing flexible sigmoidoscopies for 17+ years and I apply the same pricipals of scope advancement as the doctors use with the colonoscopes. The difference is I have the patients, who are not sedated, turn to their backs and press on their lower left bellies themselves. I achieve two benefits: I can better straighten the scope in the bowel and the patients become part of the team in getting the best possible exam they can. Currently we are using the 75cm Olympus scopes in our flexible sigmoidoscopies and with these methods I have been able to advance the scope many times into the cecum. Its good we have a camera to document the appendiceal orifice and terminal ileum because there are a lot of skeptics in family practice but our GI docs are used to us doing this and its fun to hear them say when questioned, "Yeah they (RN endoscopists) do that a lot!"

Patients are repositioned during a colonoscopy to facilitate scope advancement. Sometimes a scope comes to an impass and is unable to proceed and moving the patient creates a new configuration to the turns that makes it easier to maneuver around. In our GI lab the staff is always concerned about protecting the patient's privacy and dignity. We redrape the patient to provide maximal coverage while keeping the work area clear. I'm sorry you felt so exposed and embarrased. It would be helpful if the GI staff heard this feedback. In these days with so much emphasis on patient privacy and confidentiality these types of incidences need to be brought to the forefront and addressed. Pain with scope advancement is not necessarily inevitible. The colon has no nerve awareness to touch. A biopsy or polypectomy are conducted with no sensations occuring. The digestive tract, however, is wired for stretch reception. If there is no stretching there is no sensation. The straighter the colon the less stretching occurs and the easier it is to have a scope advance through the colon. I have been doing flexible sigmoidoscopies for 17+ years and have gotten to the cecum with 65-75cm Olympus and Pentax scopes many times WITHOUT SEDATION. Men seem to be plumbed with straighter colons and I have successfully examined the entire colon on more men then women for that reason. Women tend to be more curvatious inside and out and advancing around the sigmoid and splenic flexure can be intolerable. This is especially true for post hysterectomy females because the organs drop into the pelvis to take up the space vacated by the uterus. Aren't we women so special?! There is a down side to sedation. If the doctor is concerned that your blood pressure or respirations will be compromised with additional sedation you might be asked to bear with the pain until the scope has passed the difficult area. That happened during my colonoscopy. I have a high, tortuous splenic flexure and you bet I felt that turn. It wasn't fun but I know I was safe and appreciate the doctor working with me to complete the test without incident. In our GI lab biopsies are not routinely taken when the patient is asymptomatic and no abnomalities are found. There are lots of reasons for OB+ stool. Bleeding hemorrhoids, if tested in the office with a digital rectal exam the examining finger might have caused trauma and created a false positive. If red meat was eaten in the previous 2 days the blood from the meat might have been detected. Or there could be an upper gi bleed. Anyway, unless there is reason to suspect microscopic colitis or there is a history of colitis there is no need to "routinely biopsy". Post colonoscopy pain is likely a sign of air trapped in the folds. A very tortuous colon will be harder to eliminate the gas. A colon with extensive diverticular disease has thickened, tortuous folds that trap the air and can be very painful. A patient should keep moving to promote peristalsis and expelling the air. Even turning the patient from side to side and encouraging a good "fart" is helpful. Air trapped inside triggers vasovagal responses resulting in drop in BP and Pulse rate, dizziness, diaphoresis, nausea. Its not a pretty picture. We always stress the need for our patients to push out the air. It is "music to our ears!"