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]

Observation: the propaganda that is offered on flex sig and colonoscopy by the major orgs on their websites or in print (ACS and AMA) would have you believe that neither procedure is stressful or painful in any way. However, if you read the actual experiences of people who submit to them (numerous message boards), the responses are strikingly different. One wonders why the promotion orgs insist on slanting the information so much when the reality is quite different (my flex sig certainly was no picnic--never again).

I can't understand why a doctor who is causing so much pain (see several of the postings) would continue the procedure(?). And why can't the patient say "stop"? My own doctor was hell-bent for "full insertion" and wasn't about to stop for anything. Jeez, even my dentist will stop and let me have a "breather" if things get tough.

I, too, am a fretter. Major. 6 weeks of anxiety before my procedure almost did me in, but I got NO help of any kind from my prescribing doctor (a GP who admits to never having had either one). I don't get it--if these procedures are so important, why won't the docs make any more effort to give them a good reputation?

BTW, neither of the docs I dealt with for my procedure are my docs any longer. And with respect to Katie Couric, of course hers will be good. She's on TV for heaven's sake. They're not going to broadcast her having a bad one. You can bet she had all the good drugs and plenty of them.

[mshultz]

I am not a nurse, but would like to share my colonoscopy experience. While researching the procedure prior to my exam, I stumbled upon http://www.colonoscopysafety.com by Dr. Jeffrey Hadley, who recommends having a colonoscopy without sedation. Being insatiably curious, the idea of being able to watch the procedure really appealed to me. I got up the nerve to write to my gastroenterologist requesting the reduced dose of sedation that he had given me during a gastroscopy the previous month, which had not affected my memory or mental status (I had lost about 4 units of blood due to a duodenal hemorrhage). Dr. Hadley made the procedure sound relatively easy to bear, and I assumed that a sedative dose too low to affect mental status would still have some anaesthetic properties. When I was wheeled in for the colonoscopy, the gastroenterologist said that he would follow my wishes, and that if I needed more sedation, to just say so. Early in the examination, I asked the doctor if the brown particle I was seeing on the screen was fecal matter. He answered "Yes, but don't concern yourself", and sounded uncomfortable. I was not embarrassed, as I had followed the prep instructions. I just wanted to make sure that I understood what I was watching on the monitor. As he worked his way through the sigmoid colon, the pain increased to where my face broke out in sweat; something that had never happened to me before. Thankfully, the nurse wiped off my face before the sweat could run into my eyes. The cramping sensation from each introduction of air would go away, but with no reduction in pain. The pain seemed to increase linearly as the colonoscope was advanced, leading me to believe that the mere contact of the side of the colonoscope against my colon was painful. As he worked his way through the transverse colon, I was beginning to doubt my ability to endure the pain. With the next increase in pain, I felt like I was on the verge of a complete physical collapse. This feeling scared me, and I stated (in what sounded to me like a calm voice) that I needed more anesthetics. Prior to this, I had twitched once, but had neither cried out in pain nor shed any tears. The nurse reacted so quickly that I wondered what my vital signs looked like. As she was injecting the remaining drugs from both syringes, I was still hoping that I would be able to remember the rest of the procedure. Assuming that forward progress of the colonoscope was paused at this point, I noted that there was no decrease in pain. The nurse asked the doctor "Are you encountering resistance?" This same phrase was used in the ED when I had protested during the insertion of the nasogastric tube. It must be something taught in nursing school. The doctor said that he was having difficulty. My last remembered thought was "This really hurts!"

At my next appointment with the gastroenterologist, I thanked him for allowing me to watch what I could of the procedure. He explained that I had been at the most painful part of the examination when I gave up, and that there were a couple of things that he had wanted to show me (anatomical landmarks; I had no abnormalities). I was greatly disappointed to hear that I had come so close to success, but said nothing, as I had made the best decision with the information that I had at the time, and since I was not complaining, the doctor had no reason to tell me that I was approaching the hardest part, and that it was soon going to be less painful. He said that he was sorry for the pain that I endured. I replied "Don't be sorry for me! It was a choice I made!" When I filled out the customer satisfaction survey from the hospital, I thanked the doctor for letting me watch what I was able to endure. I gave top ratings in every catagory, just as I had for my ED and CCU hospital stay.

A couple of interesting notes about sedation. The doctor was surprised to read that I remembered the gastroscopy. After the colonoscopy, the doctor had to tell me the results twice, since I had no memory of seeing him in the recovery room (I had stated to the nurse that I did not want the doctor to talk to me in front of my parents (too personal and uncomfortable for me)). I had temporarily stopped taking Protonix 24 hours before the colonoscopy. According to a recent Medscape article, H2 blockers slow the breakdown of benzodiazepines, and I had regained awareness only a few minutes prior to being wheeled out of the recovery room. The amnesia caused by the Versed completely blocked any awareness of mental status changes from the Demerol. My legs were wobbly as I followed my parents to the car.

After considering the matter for a couple of months, I have decided that I will watch my next colonoscopy, only without any sedation at all, since it does not seem to do any good in a dose that does not affect memory and mental status. In fact, I am almost looking forward to it. Since my body is undergoing the same abuse whether or not I am sedated, I guess the worst that can happen is passing out from the pain. If so, just monitor vital signs and proceed with the exam. If I want to be sedated when I regain consciousness, I will say so. The pain did not make me nauseous, and since I was able to behave myself, I want to try again. An advantage I have is that while I have unpleasant memories of painful events during childhood, and can empathize with others in pain (like the other posters to this thread), as an adult I can remember painful events without being bothered by the memories. Furthermore, the only mental status I like is alert and oriented. The Versed induced amnesia bothers me. This ability is a mixed blessing. Since I could not see the damage being done by taking 5-6 Anacin a day to control headaches, and the GI discomfort did not affect work or school, I ignored it. I also ignored the significance of having half a dozen ED workers immediately surround me, remove the blanket covering my naked body, introduce themselves, and start working on me without even asking my name. I was convinced that while I needed to be in the hospital, it was not all that serious.

[bbarbie1]

mshulz: Do you also have dental work without analgesia? A root canal without pain meds might be an interesting experience.

I guess I don't understand why, with modern methods for pain relief, why anyone would chose to do something like colonoscopy without sedation or pain medication, especially after reading the previous posts. Why would anyone voluntarily undergo a routine screening procedure that causes the person to scream with pain? Am I missing something? And why would anyone ever have a repeat procedure? After all, this is not the Spanish Inquisition or Nazi Germany, this is the USA in 2004. Yes, there are certain risks involved with all anesthesia--even with novocaine for dental work. There are a small but significant number of cases in which the needle used to deliver novocaine damages a nerve in the mandible and causes permanent damage, but I'll take my chances.

With the understandable emphasis on getting people in to be tested, I feel that it is important to make the experience as comfortable for the patient as possible or they will not repeat the procedure. Inform the person of all the risks and let them make the choice about sedation, but try to be as honest about potential pain as possible. It is a disservice to patients to gloss over this aspect and subject them to unbearable pain. And a rethink of the use of the word "tolerable" with respect to -oscopy procedures might be called for. Does tolerable mean you will survive but experience horrible pain? Or does it mean something else? I personally have a great distrust for procedures termed tolerable after reading the posts above.

[mshultz]

bbarbie1:

Thanks for the reply. I do in fact have dental work done without analgesia. As one who grew up before fluoridated water became common, my childhood visits to a "child-unfriendly" dentist were often unpleasant. I was a teenager the first time I received Novocaine. By then, I found the lingering numbness more unpleasant than the pain. I have had two root canals with Novocaine. Prodding an exposed tooth nerve is quite unpleasant, let alone a root canal. Although Dr. Hadley emphasizes the risks of sedation on his website, this was not a factor in my decision, as the risks are relatively low. I had noticed that Dr. Hadley seemed a bit fanatic in his belief. Certainly, no one in this thread is saying that a colonoscopy without sedation is not that bad, including me.

What are the patients saying when they fill out their post colonoscopy surveys? This thread is almost surely biased in favor of bad experiences. I agree with you about giving patients informed consent. A local newspaper columnist with concerns about her upcoming colonoscopy said that her doctor promised that she would not feel a thing. While this is probably the case most of the time, we know that it is not always true, and I would have trouble trusting a doctor willing to make this promise.

The current Crankshaft comic strip is about Crankshaft getting a colonoscopy. Do you suppose he will feel anything?

In order to understand why I would choose to undergo a painful procedure without sedation, you have to understand my personality. I am a control freak. I have never consumed alcohol, or taken mind-altering drugs (no tobacco use either). A good part of the reason is that I fear losing control. May 6, 2003, I was taken by squad to the ED, and then transferred to the CCU due to a duodenal ulcer hemorrhage that resulted in the loss of about 4 units of blood. The worst part of the experience was not regaining consciousness to find myself surrounded by a huge puddle of blood and fecal matter, nor was it finding myself unable to sit or stand, and too weak to clean myself up. I was concerned, but not scared, even though my heartbeat was weaker than normal. The worst part was the realization in the ED that they could do anything they wanted to me, no matter how unpleasant. I was over my head medically, and checking out AMA was not a realistic option. Part of the reason that I tried so hard to be the perfect little patient is that while I could not control my body or what they did to me, I could control my behavior. One of the CCU nurses called me a low maintenance patient, so I guess I did alright. I knew that I could be different in my reactions and desires, and would have to accept that the hospital would be geared toward the average patient. The emphasis is on relieving patient anxiety, and since I never questioned the need for any procedures, and refused only to watch television, they probably had no idea that I considered my condition serious, but not life-threatening.

Since I left the hospital, I have been reading everything I can in order to understand my condition and treatment. Nursing books are good because they explain the rationale for treatment and procedures. This forum has also helped a lot. What continues to puzzle me is how normal people react. It has taken me over 7 months to begin to understand why amnesia is a desirable sedative property (normal people do not want to remember unpleasant procedures). I got an advertisement in the mail a couple of days ago from a dental clinic offering dentistry under sedation so that you would remember little or nothing of the procedure. My first thought was "Why would anyone want that?"

[bbarbie1]

mshultz: In answer to your question about why anyone would want amnesia--let's think about the procedure. Someone I don't know, and who doesn't know me or care about me as a person (except to be concerned about whether my check will clear), is going to force a 6-foot-long lighted garden hose up my backside, all the while driving it around with his little joystick. That's not an image I want to remember, it's the stuff of nightmares and sleepless nights. I find the whole procedure demeaning and humiliating. During my flex sig I craned my head around to see the doc hunched over with his head near my rear, peering into his scope (too cheap to get the monitor), feeding tubing into my body--it literally made me so nauseous I nearly threw up (but there was nothing in my stomach except acid). So I'm glad for amnesia, thank you.

[mshultz]

bbarbie1:

So, another reason that a person would want to be sedated is to avoid remembering a humiliating procedure. Thanks for the insight.

[bbarbie1]

Crud. It looks like I get to have another colon inspection, yuck, yuck, yuck. I had a major cancer scare this week: a CT scan looking for the cause of back pain found instead things that looked like bony metastesies, and a 1.3 cm thing in my liver. After a bone scan, ultrasound and an MRI and various other insepctions, the cancer is mostly out of the picture (one more result to get in), but my doc wants to be aggressive about prevention and have me get the colonoscopy. After being relatively calm about potential bone cancer and all the other stuff, this procedure has me in major panic mode. Doesn't make a lot of sense, does it? I guess the memory of the flex sig, disgusting thing, it still too fresh. I hate the thought of giving up all control of my body to someone who will most likely cause significant pain that I just conveniently won't remember. I do think that's the best way, not that it gives me any comfort.

Does anyone have an opinion on whether it's better to have an old experienced doc or a younger one, given that the training is equal? One older guy here was trained at Mayo, but one of the younger guys is also good, with the added benefit that he actually has a personality. And what would be a suitable pharmacological agent that can help keep me calm up to the procedure? I have to be able to function, can't afford to be a vegetable (I teach).

I really, really hate this procedure. It's personally offensive, demeaning, and humilitating. (Maybe if I say it enough I'll get desensitized.)

[mshultz]

bbarbie1:

I wish you the best of luck with your health problems.

[bbarbie1]

I'm an RN who has worked Endo for 8 years. The vast majority of our patients do very well with Versed and Demerol. I can't tell you how often the patients ask me "when are we going to start?" as I'm removing the blood pressure cuff and ekg patches.

Unfortunately, there are the few who don't respond as well to moderate sedation and experience extreme discomfort and remember the whole thing. I sure don't have any explanation for this. As a general rule, younger patients need more medication for sedation....but not always. I think 2 of Versed is a little on the light side....it's very common for me to get 5 or more of Versed.

For whatever reason, I think nurses are harder to sedate. I can't explain it, but I'm not the only one who has commented on it.

I've noticed that our physicians are using alot more MAC anesthesia in the last few months. Today I had a male patient who had been sexually molested as a child and was a nervous wreck about the procedure. We had an anesthesiologist administer sedation....versed, fentanyl, and diprivan and the guy did great. I don't think this patient would have been adequately sedated with Versed and Demerol.

Anyone who has had extreme pain during a colonoscopy should discuss alternatives with his doc. And if the doc doesn't take you seriously then find a new doc.

Sorry you had such a miserable experience. I hope it's better next time around.

To all endoscopy nurses, I could use some reassurance please. In trying to prepare myself for an upcoming colonoscopy, I have been browsing the web for other people's experiences. Some are comforting, some terrifying. Great. How do you get a realistic idea of what to expect? Also, if you are really in pain, will the doc stop if asked? The big question--I came across a very disturbing site, Gastro-Pro.org. I don't know if this is a demo for an instrument or a demo of the procedure, but now I'm really worried. It really seemed like the doc was being very harsh in moving the "thing" around in this poor lady. Several times it seemed like he pushed it into her very rapidly and a long ways, more that would seem safe. I noticed that the attendant kept patting her on the shoulder, so my bet is that she wasn't very comfortable. It this "gentle" treatment? I have never observed a real procedure, and would like the opinion of those who have. It sure seemed like he was more interested in pushing and pulling on her (showing off for the camera) than in being gentle. I'm really beginning to distrust the stuff I read about "gentle insertion of the scope", and all other superficial statements intended to lure people in for screening. I would appreciate any input. Thanks.

[athomas91]

it is a fine line .... sedating someone enough to keep them breathing, providing enough analgesia for the procedure...and having them wide awake after....

the bowel is a funny thing... you can cut it w/ a knife and it won't hurt...but you dilate it and it has been referred to as the worst pain imaginable...

and after the dilation is done and the air dissipates you are pain free...so ....

the problem is alot of doc's give a certain amt of sedation and analgesia to start...they chase the pain w/ narcs when the pt c/o's of pain...

i am sorry that your experience was so painful...

[Chrislynn2003]

I had my first colonoscopy done when I was 11 when I was diagnosed with ulcerative colitis. I was sedated pretty heavily; do not remember hardly anything. My UC kept getting worse, so the only option was a total colectomy, which I had done 5 years ago. A colonoscopy is not the worst thing in life.

[bbarbie1]

I had my first colonoscopy done when I was 11 when I was diagnosed with ulcerative colitis. I was sedated pretty heavily; do not remember hardly anything. My UC kept getting worse, so the only option was a total colectomy, which I had done 5 years ago. A colonoscopy is not the worst thing in life.

I'm sure it is not, but since I haven't had one yet I really have no way of knowing that. After spending 3 days in testing and another 2 waiting for results about possible bone and liver cancer, this is the last test I have to do, and I hope it dispells once and for all the diagnosis of cancer. I'm worn out, stressed out, and the idea of having that thing stuck up my butt is not exactly appealling. All I was asking for was some information.