Colonoscopy without sedation

[nursepract]

I'm 54 and have beeh having dark blood in the stool as well as recent onset change in bowel habits (alternating constipation/diarrhea) as well as a bad family history of colon cancer.  Since I'm a nurse, it seems like a no-brainer that I should get a colonoscopy, althought my doc said not to worry (she's making me feel like a pest for asking) and told me to take metamucil.  I can self-refer fo rthe test, but I want to have it without sedation; after recommending this test to hundreds of patients and seeing a number of them performed, I just won't do the "conscious sedation"; I have seen too many people with long-term memory impairment from Versed to consent to this.  About 10% of these exams are done without sedation (and most other countries don't use sedation), but when I try to schedule one, they "insist" on sedation.  Oh, and of course I'm allergic to eggs, so propofol is out, ut even if I wasn't I would not do the sedation.  Should I keep trying or give up?  What's the big deal with doing the exam without sedation?  I know it's uncomfortable; heck, I have seen a number of patients literally scream for the doc to stop the colonoscopy and this was with Versed; they rely on the amnesia effects to stupify the patient.  What bothers me, is that I see a lot of patients who have a PTSD-type reaction later when they start to remember how they were treated. I would rather experience and remember the discomfort.  My doc says that she would never get this exam, drugs or not........thanks

[n85082]

I appreciate all of the info. For what it's worth I did speak to the nurse anesthesia person who works on a contract basis with the local university gastroenterology clinic  with my concerns over colonoscopy sedation and she arranged for one of the gastro's to call me.  I was surprized at how candid he was when he told me that sedation for colonoscopy has become a significant issue, especally with Versed.  Most patients find the drug adequate (or they don't remember anything), but that about 1 in 10 have a bad experience..sometimes quite bad.  He said that they would use diprvan (propofol) for all of the endo procedures, especially colonoscopy) if the insurance companies would cover the CRNA services which can be quite expensive.  I asked him if any patients "screamed their heads off" and he said that for some patients the exam is very painful and that there are upper limits to how much Versed can be given.  So basically, yes some patients do have a terrible experience then go on to remember every detail.  In his words the Versed procedural amnesia was "a crapshoot" and may or may not occur at all; in some patients the amnesia is very problematic and long-lasting. This guy was very honest and liked propofol and would not get the exam with Versed.  He is the department head and agreed that perforation wouild not occur in an unsedated patient; sedationless colonoscopy can be and is done but most places push the sedation for the ease of the operator and with patient comfort if propofol is used.  He said that with 10% of patients having bad  experiences with Versed, that was unacceptable, but the insurance companies were too cheap to pay for propofol.  I asked if I he thought that an unsedated exam would be the way to go for me (previous bad experience with sedation), he said it would be a good option, but that they didn't like to do them that way.  I mentioned a possible family history of FAP and he sort of changed course, suddenly the risks of sedation that he was previously railing against were now insignificant.  That gave me whiplash. Well, I did certianly try.

[Canyondweller]

You can get a virtual colonscopy where you don't need to be sedated. You have to do the same prep and you get it at a outpatient facility that does MRI's, etc. It will show if you have polyps but of course they can't remove them but at least you would know your risk and weigh it out. Limited Versed really shouldn't affect anyone that much. When it does they are overmedicating you. It is supposed to make you not remember but they don't have to give you a horse's dose. It can be done ever so slightly.

[n85082]

thanks for the info; I have little medical background other than a terrible previous experience with sedation which precludes me getting it again.  I appreciate that many people and their relatives have good experiences with sedation, unfortunately I'm not one of them (and there are evidently a lot of others who have had terrible experiences also)...I can accept the fact that I can't seem to find a doc to do the test without sedation so I guess that I can't get a colonoscopy, maybe the FAP genetic thing won't be a big issue. I love the "let them die comment" above....

[ggreg]

Why don't you get a colonoscopy without Versed... they have other drugs they can use to relax you and kill the pain.  They can also actually knock you out in the operating room and do it that way.  With your history, which I read in your other post, you need to have a colonoscopy.  And I can tell you from a relative's experience that having them without sedation is cruel.  There ARE a few people who have problems with whatever sedation that particular practice uses, either too little or the wrong drug.  So, talk with some of the gastro offices in your area and find out what drugs they use, and so forth, until you can feel comfortable giving it a shot.  With your history, you will need an exam and removal of your polyps often.  The alternative is much more horrifying than anything your concerns can produce.

[n85082]

If you think that memory problems with Versed are rare, check out askapatient.com under Versed.  The patient comments scare me to death.  I don't realy know my family history since they died young and had something called FAB or FAP or something like that having to do with  polyps.  I tried to schedule a colonoscopy without drugs and they cancelled it at  the last minute.  Doctors whorespect your wishes?  Haven't found one and have pretty much stopped trying; one nurse told me jokingly that anyone who tries as hard as I have to get a colonoscopy must be nuts. She's probably right.

[April2]

With my first colonoscopy I wanted to be able to see the screen and what was going on so I asked the doctor if they could just lightly sedate me, just enough to take the edge off and that if it got too painful then he could give me more. He agreed. He was so considerate too. He started out and I did great at first. I could watch the screen and ask questions. But when he got to a certain point in my colon where there was a turn or twist I felt sudden tremendous pressure and pain mounting and I said "Stop!" and he stopped immediately. He asked if I wanted more medicine and I said "Yes" and he nodded to the nurse who put more in my IV while the doctor waited. That was the last thing I remembered till they woke me telling me it was all over with.
I do think it's important to find a caring doctor who will respect your wishes. They are out there.