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Colonoscopy without sedation

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
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Avatar universal
Well, you may wish to have a CAT scan, or a barium enema, there are several diagnostic tests that can be done besides colonoscopy, particularly if you have a mass in the small intestine... colonoscopy would be useless in that case, and instead they'd do an endoscopy.  As for the colonoscopy, you are within your rights to ask for no sedation, or you could go for general anesthesia in an operating room, or you can ask to have only LOCAL anesthetics and analgesis, or you could specifically ask that they not put Versed or any other amnesia drug into the mix, and instead just inject Demerol for pain.

Docs don't want to do a colonoscopy without sedation because the patient might suddenly move in pain and thus cause injury, or because the patient who experiences overwhelming discomfort might end the exam before it is completed.  

I think it is perfectly okay to choose any alternative exam or variation on the way an exam is done, if you want, and if a doc is too stubborn to respond to your request, obviously go to another group, and another, until you get what you want.  There are docs and hospitals who are doing tests of nonsedation colonoscopies, to see if this is an option that should be offered to the general public.  There are plenty of people out there that don't want twilight sedation, period, and there are docs who will respond to that request, particularly when the patient has had a bad reaction to Versed, which can indeed cause some instances of pretty dramatic and negative amnesia experiences.
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Avatar universal
Thanks for the info, local anesthetic for colonoscopy wouldn't work and GA would be dangerous overkill; I don't even think that the sedation part is a good idea, but some people seem to want it. the choice seems to be: risk receiving a drug that you have a know bad reaction to, or skip the exam.   I would  never do conscious sedation again and only consent to GA if I was dying.
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Avatar universal
I would never get sedation after watching 2 coloncopies where one patient screamed her head off; they ignored her hoping that the temporary amnesia from Versed would get her out the door....I very possibly have colon cancer and need a colonoscopy-can't find anyone to do it without sedation.....therefore will not have it done
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168348 tn?1379357075
We started out with my colonoscopy without sedation and then some sedation and I do vividly recall I was moving about too much and they were concerned I could get hurt by the movement and they asked my consent before administering more sedation.

They found an atypical polyp ........I am overdo for my followup exam by 2yrs worth .... really foolish on my end I know .... but due to the dehydration and a kidney stone problem/history I have, I am scared to get it again ..I had a major kidney stone attack 8 hrs after I got home and almost ended up in the ER that night.  Some have suggested 23hr procedure and stay there with IV bags of fluid for quite awhile before I go home vs. in and out.


C~
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915277 tn?1252573113
I worked for gastroenterologists for over 10 yrs and have seen many colonoscopies and egd's and I have never see anyone scream their heads off...I have had 6 colonoscopies myself and have been awake for a couple of them and had polyps removed and I felt absolutely no discomfort at all.  The reason they give you versed and fentanyl is to put you in a twilight sleep so that if they ask you to move slightly, you can and do follow those orders,  and to relax you.  As far as long term memory impairment from the meds, in 10 yrs, that never happened with any of our patients.  And your doc says she would never get this test??  Colonoscopies save lives everyday by the early detection of colon and rectal cancer and the removal of precancerous polyps and for a physician to say they would never have this test goes against the first tenant in the Hypocratic oath...First do no harm!!  Unfortunately, stories like this one are what scare people so badly that they put their health in jeopardy rather than have a simple 15 minute test.  I am surprised that you, as a part of the medical profession, would perpetuate such horror stories, which in turn could indirectly jeopardize another's heath, and possibly a life...
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915277 tn?1252573113
You make it sound as if the doctor doing these tests mistreated their patients while they are under the effects of the meds, if that was the case did you report said doctor??  If you saw mistreatment of a patient and did not report it, then you are just as culpable as the doctor!  I don't fully understand why an NP would be coming to laypeople for answers, when surely you have colleagues to consult with on this issue...  
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Avatar universal
I TOTALLY agree with with joycekatherine.  I also worked for 2 GI doctors and never witnessed anything like this, if I had, I would have definitely reported it!  Also, I have 2 kids and one deceased son who had to have colonoscopies all their lives due to inheriting FAP, and never did any of them experience any of this and they were just kids.  My 38 year old son and 37 year old daughter, and 16 year old grandson have them yearly with absolutely no problems.  I have a deceased grandson that endured them all his life also.  My son would not be with us today if not for the colonoscopies.  At the age of 12 he had cancerous polyps discovered by a colonoscopy!  I find it hard to believe that any doctor would say they wouldn't have this test, they know too much not to recognize the benefits.  I also have had several and nothing like this happened to me.  My husband has had several, no problems. This is a test that may save your life, but you're being closed minded in not realizing what a great diagnostic test this is.  You can't run or hide from cancer, or ignore it.  If you're scared now, let your symptoms go, and you'll learn what real fear is! You have the opportunity to stop something before it's get serious, or becomes too advanced, all because you didn't want the test.  Millions and millions of people are saved by this one test, what are you thinking?  I'd also kick your doctor to the curb, what lousy advice, and you should know that this is not correct. That doctor needs to be reported for stupidity!  If you're a nurse then you should know the answers to all of your questions, and also know you need to do.
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Avatar universal
I just spoke to my son who has yearly endoscopies, and colonoscopies and was telling him about all this.  He told me to stay out of it, he said "my God, if these people want to die, let them! "  He just can't understand how people, supposedly intelligent people would  make such a rediculous, reckless decision regarding their well being and life!  He said "mom, if they don't care, why should you?" He's right, you have to choose for yourself.  But I do hope you keep your "horror stories" to yourself, as we all want to see people live long, healthy lives, and you're not helping.  People come on here looking for help and advice, not to be scared to death with this nonsense.
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Avatar universal
I'm not trying to be mean, but with your comment on here, I can actually see a child stomping their feet and storming out of the room, because mommy took the scissors out of his hands!  
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Avatar universal
The main risk with colonoscopy is from perforation of the colon and from the risks associated with sedation.  This can be eliminated by simply skipping the sedation as mentioned by rem223.   Unfortunately I have been recently bothered with symptoms that would indicate getting a colonoscopy, but after reading domments on askapatient.com about Versed, no way.  This exam is done in most of the world without sedation, but in the USA most patients who desire to have a safe and unsedated exam are pressured into "agreeing" to something that they don't want or need.  My insurance pays for this exam 100% and I don't need a referral, but I sure can't find a place that won't do it unsedated.  This is a crock.  I'm sure that a significant number of patients go unscreened because they are not offered the option of a safer, unsedated exam.
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957421 tn?1247084596
Well, you might want to go to the doctor I fired if you don't want sedation. Although I had the IV I was totally awake and was in such severe pain almost the entire pain that if I had had a gun I would have shot him. I hollered stop for almost the entire time and he kept saying we are almost done. Well, I fired him and have had 3 since with sedation(different doctor) with absolutely no problem. Am awake the minute it is over and ready to go home though they won't let me go right away. I have never heard anyone holler and have problems with the sedation like was mentioned early on this thread. Someone is overmedicating. They use Versed and another med at minimum doses to keep the patient comfortable. I also have endoscopies every other year with lower sedation. I am 72 and live around other people my age and never have any of them experienced what was mentioned about the memory. To me that reeks of poor quality care and is very rare. I don't think any Doctor will do it completely unsedated without at least the IV but there are some here that will keep you awake enough to watch it on the screen but not everyone's insides is a straight shot so you may be sorry. The risk is much greater of not having it than having it with sedation.
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203342 tn?1328737207
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.
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Avatar universal
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.
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Avatar universal
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.
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Avatar universal
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....
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957421 tn?1247084596
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.
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Avatar universal
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.
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Avatar universal
Why don't you call your insurance company and ask if they cover colonoscopy sedation with propofol.  Then ask them to give you a list of sedation that they do cover.  Then ask the place where you're supposed to get the colonoscopy if they would use whatever accepted anesthesia the insurance accepts.  Also tell those people you are freaked out about it, and you will need to be tranquilized on top of everything else just to get you in the exam room.  (They gave me that in the outside office, and then injected me in the procedure office with whatever else they gave, but it was not Versed...that stuff is dated.)  Hope this helps.  Bring you a flask of whiskey so when the whole thing is over, you can gulp that down and forget about the whole thing a lot quicker!
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Avatar universal
The comments here and yours in particular prompted me to continue my search for sedationless colonoscopy.  My insurance pays for anything, even the Michel Jackson drug propofol, but Iwould prefer nothing.  I met with a gastro today who knocked my socks off.  I went in planning to argue with her, but she read over my file, especially my terrible Versed experience and said "holy s**t, no wonder you don't want sedation.  She said that she could do me without it and that she had done colonoscopy on several of the nurses in the office without sedation; it's no big deal and not too bad, she promised to talk me thru it.  She also wants to try an EGD at the same time, "if I will let her"...this might be difficult, but heck, why not.  After arguing with gastros who "insist that colonoscopy requires sedation", it was great to meet one that has done many without it.  I didn't have to argue at all.  It was gratifying when I checked out to see that the nurse had crossed out the :"driver required" part on the instructions since I won't be getting sedation.  So it's scheduled for the 17th; this doc was great, easy to talk to and no BS.  She did tell me not to worry, but she said that my symproms were potentially problematic, so let's do the test and you are NOT crazy for requesting an unsedated exam.  Thanks for the encouragement and I might just bring the whiskey flask to the test, but them I WILL need a driver.....Thanks again!
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Avatar universal
I got the unsedated colonoscopy and EGD done on friday.  No problems at all!  What a difference a good doctor makes; I'm sure that a lot of marginal gastros who do these exams rely on sedation because they are in a hurry to do them quickly, I don't know.  The gastro doc who did mine was a real angel; she was honest with me about the unsedated exam (evidently they get quite a fwe requests for them), she said that there is usually some cramping with the colonoscopy but if she went slowly it would not be bad.  The colonoscopy was a piece of cake and I learned a lot being able to watch the screen and remember it since I didn't have the amnesia drugs.  The EGD was a little harder for me since I have a strong gag reflex but we got it done.  One thing that made it easy was the fact that I trust this doc 100%.  The results from the EGD were fine, the colonoscopy indicates the need for frequent exams.  At the end, I guess that I was tired (up a lot the night before) because I fell asleep even without drugs and they didn't wake me up...She was standing by the bed when I woke up and asked me, now that you have had an unsedated colonoscopy, how do you feel about having another one?  I said no problem.  She smiled and said that was wat most unsedated patients say and that patients who have had sedated and unsedated exams prefer no sedation. So maybe I'm not so weird after all. Thanks to all for the help.
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Avatar universal
Great-another unsedated colonoscopy success story!!  There ARE a few good doctors out there who actually care enough aout their patients to take a few extra minutes and so a slow and careful and basically painless exam rather than "insist" on sedation.  Not everyone wants the dubious benefits of sedation with Versed (as well as the well-documented problems that some face), nor can everyone afford anesthesia services with propofol (no Michael Jackson comparisons please).  Patients shouls have the option as to how they want to have the test performed.
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Avatar universal
Even though this thread is old, you comments about the severe problems that a LOT of patients are having with Versed sedation are becomming quite well-documented.  The doc who did my unsedated colonoscopy verified that about 10% of her colonoscopy patients complain about Versed; everything from PTSD-type reactions to long-term amnesia.  Read Allexperts under anesthesia, the anesthesia doc Starkman recently commented about many problems with Versed for endoscopy like long-term amnesia etc.  My doc said that she would not use Versed if insurance companies would cover propofol...neither she nor any of the nurses at the endo center(they do thousands of colonoscopies) said that they would consent to Versed.   They use the drug only because it's all that most insurance companies will cover and many patients are too spooked to try the exam unsedated....I though that unsedated colonoscopy was a breeze; I felt bad while I was dressing post-procedure to see Versed sedated patients babbling, some crying and worse.   Now if I can do an EGD unsedated.....
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Avatar universal
Glad you finally got that colonoscopy, n85, and I'd like to again point out to others that if you don't want Versed, and you don't want Propofol, then they can give you anything from an ordinary mild tranquilizer, all the up to the strong pain killer Demerol, really any number of medications can help relax a person or make them feel good, and yet are not "twilight sedation."  And n85 has proved that there are indeed sympathetic gastros who will do a colonoscopy without any drugs at all.  For others who are not worried about it, I am one of the nine in ten who did not have a problem, and in fact I gotta say it was the best day I had that particular year, as I had a terrible problem with my guts for months, so it was a relief to feel good that one time.  It won't be long before nobody uses Versed anymore, so from everyone's testimony here, do not be afraid to ask for some alternative solution.
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Avatar universal
I had my first colonoscopy today.  The prep was annoying, of course, but not intolerable.  Having recently had an upper endoscopy exam done with Versed, I felt very confident that this also would go just as well.  
I was given versed and demerol for the colonoscopy, and woke up in recovery to nurses and my husband asking me questions and I was unable to form words.  Once i could, i told my husband i was glad it was over becuz i had just had a terrifying dream that i was in there screaming in pain and that i remembered and felt everything.  I thought it was a dream until the doctor came in and told us the procedure was incomplete because I was in so much pain and screaming, and then my blood pressure started dropping too low and she stopped.
It was still low in recovery, probably why i was unable to speak.

I want to have this screening done.  I followed all the directions, and went in with a positive attitude about it.  Not sure what to do now.
I have IBS and fibromyalgia, but had told the doctor that as well as that i've had two incompleted sigmoids done (no sedation) that were stopped due to intense spasms.

I'm feeling depressed and kind of frightened still, but it's only been a few hours.  
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