Colonoscopy, Guess What

[MikeD]

Brother woke up in the middle of his. Demanded more drugs RIGHT NOW!

I sorta woke up during a procedure on my foot. I was on a drug that made me not care if something hurt, which was very important to me. I stated to the orthopedic guy who was chiseling away at my infected heel bone "Wow, that really hurts alot!" I remember not caring that it hurt though. The anesthesia Dr. said "I'll just turn this up a bit." That's all I can remember. Went to work after and was sent home for being useless.

Mike D.

 

[HelpMeRhonda]

I'm 5 weeks post-op on full-blown shoulder surgery. Surgery went well, but I had major issues with pain meds. After 2 days, I decided to get off them. But took another week to flush from my system.

I was all worked up over possible complications of the surgery, never thought pain meds could be an issue.

 

[Nords]

I put it off and put it off, finally my family doctor took control. I am now four weeks post-op and the cancer was removed by a procedure called TEMS.

What started the whole thing, poboy? Was a colonoscopy done for family history or just because it was overdue? Any other symptoms?

Sigh... my father has a polyp history too. I thought showing up early for PSAs & DREs was bad enough, let alone colonoscopies.

So, Rich, are colonoscopies backed up by evidence-based medicine, or is there a "better" way? It's not as if we're just tweaking an already painless & effortless procedure...

 

[Rich_by_the_Bay]

So, Rich, are colonoscopies backed up by evidence-based medicine, or is there a "better" way? It's not as if we're just tweaking an already painless & effortless procedure...

Alas, yes. They work to save lives for this disease (colorectal cancer) and nothing else really does that very well.

They are a bit invasive for a "screening" procedure which is why you wait for age 50 or so. Fecal occult blood testing is a poor second place procedure: misses quite a few cancers and polyps, and if you have a positive test under controlled conditions there are a vast number of false positives, leading to... too many colonoscopies. Virtual colonoscopies are a) not quite as sensitive or specific and b) don't allow all-in-one management -- when you find a polyp by colonoscopy you usually just remove it at that time. With virtual studies or barium enemas, you have to be rescheduled for a colonoscopy.

I would add that up to a quarter of small polyps are missed on colonoscopy -- repeat colonoscopy later that same day identifies them. Glad I didn't volunteer for that study. Fortunately, the small ones usually progress so slowly that you would likely pick them up next time around.

The good news is that you only need it once every 10 years if normal, and the procedure is proceeded by a DRE anyhow. Trust me, advanced colorectal cancer is ugly.

Wish there was an easier way. Most likely to succeed in my opinion: tumor marker DNA testing of fecal samples. Another 5-10 years off, perhaps.

 

[JohnEyles]

Sorry, CT. You're off by a factor of 10.

The rate of major complications (perforation and major bleeding) is about 1 to 2 per 1000 procedures.

Plus, I suspect that this 0.1-0.2% statistic comes from a sample that does not exclude
high-risk individuals. So if you are low-risk your rate of complication is probably far lower.
I'm not sure what would be high-risk in this context (I'm not a doctor) but probably
symptoms that would suggest something is wrong with your colon in the first place -
in other words, the colonoscopy is something other than routine screening.

 

[Nords]

The good news is that you only need it once every 10 years if normal, and the procedure is proceeded by a DRE anyhow.

If I'm going to feel good about anything in this thread, it's the fact that the periodicity is decennial. I thought it was annual, right after the PSA/DRE.

Plus, I suspect that this 0.1-0.2% statistic comes from a sample that does not exclude high-risk individuals. So if you are low-risk your rate of complication is probably far lower.

I think that the 0.1-0.2% comes from crappy (so to speak) technique, including improper sanitization and operator error...

Suddenly I feel an urge to eat five helpings of high-fiber fruit!

 

[donheff]

If I'm going to feel good about anything in this thread, it's the fact that the periodicity is decennial. I thought it was annual, right after the PSA/DRE.
I think that the 0.1-0.2% comes from crappy (so to speak) technique, including improper sanitization and operator error...

Suddenly I feel an urge to eat five helpings of high-fiber fruit!

I have a scope every five years - some colon cancer in the family. At least you are out cold for it.

 

[HFWR]

Doc told me to come back in three...

 

[Nords]

Doc told me to come back in three...

Three what-- boat payments?

 

[HFWR]

No, Dad had colon cancer surgery, and I had a couple of polyps, so...

Three boat payments it is...

 

[MikeD]

Three what-- boat payments?

I love that stuff. My orthopedic surgeon told me I was a gold mine: a diabetic with insurance.

Mike D.

 

[HelpMeRhonda]

I love that stuff. My orthopedic surgeon told me I was a gold mine: a diabetic with insurance.

Mike D.

MikeD are you self insured. If so, can you shed any light on being diabetic and the issues of getting insurance. I am still working primarily because I have no insurance plan after ER and I'm a 48 yr old diabetic, with spouse, 17 and 14 yrs old.

thanks for any reply

 

[astromeria]

with spouse, 17 and 14 yrs old

She must have split personality--and they're awfully young :

 

[Martha]

MikeD are you self insured. If so, can you shed any light on being diabetic and the issues of getting insurance. I am still working primarily because I have no insurance plan after ER and I'm a 48 yr old diabetic, with spouse, 17 and 14 yrs old.

thanks for any reply

Look at the Georgetown University site for information on rights you have in your state: www.healthinsuranceinfo.net

You will see when reading the guide for your state that you have the most rights if you are HIPAA eligible. If you are currently covered by a group plan and your employer has more than about 20 employees, you are probably HIPAA eligible. The complete requirements for HIPAA eligibility are found here: http://early-retirement.org/forums/index.php?topic=10228.msg186148#msg186148

If you are HIPAA eligible there should be an insurance product for you to buy. It may be one or more policies offered by individual insurance companies, it may be through a risk pool, or it may be a conversion policy. A big problem though is cost. Federal law doesn't regulate cost and states are all over the board with what they do regarding cost. Another problem is the scope of coverage available to you--some states offer coverage with pretty low coverage limits.

Whatever you do, stay away from temporary insurance. Once the policy expires you have no rights to further coverage.

 

[Ed_The_Gypsy]

...Well C. Diff or Cee-Def - Same difference to me....

Well, whatyagonnado with someone who pronounces centimeter "sonameter"?

And these are guys who memorized the Krebbs Cycle.

Go figure.

(But they had a rough time in P Chem! )

 

[JohnEyles]

At least you are out cold for it.

I was not. I recall being vaguely uncomfortable once or twice. My anesthiologist
was a nurse, so maybe more timid about level of sedation ? I think they simply
used a pulse oximeter and backed off if SaO2 got too low - dunno what the
threshold is, but I'm a person who shouldn't desaturate too easily I wouldn't
think (normal weight, very fit aerobically). Maybe Rich can shed some light.

That being said, it was not a bad experience, in fact the goofy drugs were kinda
fun (but kinda sucked the clinic doesn't trust your driver to show up on time and
make them be there the whole time). The prep was no big deal either. PLEASE
don't avoid this test out of fear - at least fear of the procedure - fear of
imcompetence screwing things up, possibly. I decided to do it after I read an
article about physical exams where the author was definitely a smart guy with a
healthy dose of skepticism about our medical system - talked about tests being
done to cover doctors' asses, that kind of thing; and THIS guy said "this test
[colonoscopy] saves lives, DO IT".

 

[Rich_by_the_Bay]

I was not. I recall being vaguely uncomfortable once or twice. My anesthiologist
was a nurse, so maybe more timid about level of sedation ? I think they simply
used a pulse oximeter and backed off if SaO2 got too low - dunno what the
threshold is, but I'm a person who shouldn't desaturate too easily I wouldn't
think (normal weight, very fit aerobically). Maybe Rich can shed some light.

Colonoscopy and other outpatient procedures are done under what is called "conscious sedation." This is a form of light anesthesia where you breathe on your own (don't require a tube or ventilator). O2 saturation is not a variable parameter here -- if it goes down too much, you may be too heavily sedated so they back off but usually it stays normal. With today's drugs you can be pretty deep and not have suppression of your breathing (unlike using only opiates which work but suppress breathing at higher doses).

I think the beauty of it is that these drugs also cause some amnesia for the time they were given (it's not total as others have stated, but still pretty apparent). So however unpleasant a procedure may have been, you won't remember much of it in most cases. I do remember awakening slightly, awareness that the procedure was under way, but no pain or distress of any kind. When you stir a bit too much, you'll probably get another hit. Not easy scoping a moving target .

 

[martyb]

I went to see a surgeon about having an inguinal hernia repaired in May of this year. In the course of doing the usual pre-op tests, he determined a small amt of blood in my stool. Sorry to be so graphic. : After that, he insisted I get a colonoscopy before he'd do the surgery. I'm only 48, which is younger than most folks have this done without some symptoms, but I went ahead. As stated in several posts, the worst part was the prep work. A few minutes after I got on the table, I was out. I didn't & still don't remember anything. No discomfort whatsoever, and no pain. The best part was they found no big problems, just a couple of very tiny ones that I won't go into detail with here. Main thing is No Problemo. I went on to get the hernia fixed 2 days later, & life is good. Regarding colonoscopy, I say "git 'er done"!

 

[MikeD]

MikeD are you self insured. If so, can you shed any light on being diabetic and the issues of getting insurance. I am still working primarily because I have no insurance plan after ER and I'm a 48 yr old diabetic, with spouse, 17 and 14 yrs old.

thanks for any reply

My wife is still working primarily so that we have insurance because we are both uninsurable outside of work group policies.

Mike D.

 

[poboy]

Just a little background. No history in my family, I had no symptoms or any kind, negative stool test. Prior to my annual checkup my doctor gave me a list of things to be done prior to my appointment, blood work, chest xray and colonoscopy. I did all but the last and as I was in his office and he was reviewing my records he could not find the colonoscopy results from the gastro. I said it must have been lost in the mail. Good doctor that I have, he excused himself and returned in 10 minutes telling me I had an appointment the next week and I would be receiving instructions. I am definitely the type patient that drive doctors crazy. After I had surgery and found out the results, I called my family doctor and thanked him for having much more wisdom than I.

 

[azanon]

I am not afraid of the Prep or the procedure itself, but the risks with having it done. People need to know that this test is not without risks!

I had one scheduled last year but canceled it after a friend of mine that was 75 and had a colonoscopy and contracted an infection that put him down for 6 months. Lost 25% of his body weight, was rushed to the hospital twice in that 6 months from 911 calls, and just about died. That is all the colonoscopies for him! He realizes that he does not have that long on this planet, and does not wish a repeat of last year. He gave up one year of fishing for a test that just about killed him!

It is also important to note that that .2% of patients that get a colonoscopy have their colons punctured!

I have to admit to being a little distrustful of the Medical Profession. I have not had very good luck with my allergies and found I knew more after 1 year than most of the doctors that I was visiting. The main piece of information that the medical offices wanted was my Insurance Company. I could tell they were listening for this information. I certainly can not explain all of the appendectomies and tonsillectomies that were done on a routine basis in the 1960's. Add to that if they find Polyps during the procedure and take them out, the hospital makes a lot more money, than if it were just a test. A less invasive procedure is needed. If .2% of airplanes crashed during their flight, I would not fly either.

That being said, if I had a family history of colon cancer, or any cancer or had any abnormal symptoms I would take this test in a heartbeat.

Edit: Corrected my error my a factor of 10

I imagine if you just took average statistics, you have a greater chance of getting colon cancer than you do this surgery going wrong. Rephrased, if you want the best chance of having something go wrong, don't get the test.

 

[gindie]

With today's drugs you can be pretty deep and not have suppression of your breathing.

Rich,
So, these drugs are also appropriate for us who have apnea?

 

[windsurf]

Recollections of my colonoscopy: I remember all of it b/c the iv line which was supposed to deliver the twilight med, versed, into a vein on the back of my hand was kinked. Cold turkey! The discomforting aspect was when the scope had to turn a corner in the horseshoe shaped colon. That was "crampy." Afterward, dressed and greeted by my wife, the nurse suggested I should go home and take a nap. Very wide awake, I said, "Hell, we're going to stop for lunch then I am going to work," and I did. I still have the couple still shots the doc gave me as keepsake.

 

[Rich_by_the_Bay]

Rich,
So, these drugs are also appropriate for us who have apnea?

If you are referring to obstructive sleep apnea, the answer is generally yes, they can be used routinely for most patients. As usual, individual factors are complicated and need to be accounted for. Central apnea is a whole other story.

I'm not an expert in anesthesiology but in my general experience, no reason to avoid colonoscopy or other important procedures if you want to do them, as long as the doctors are aware of the issues.

 

[Hydroman]

I am turning 50 next June. Have not decided if I am going to have the colonosscopy. I have personal experience with "extremely low risk" statisitics. I was one of the micro-percentage that ended up with a painful infection after a vasectomy 15 years ago.