Colonoscopy

Had one several years ago, but was under general anesthesia, so have no recollection!

I'm having my 5-year colonoscopy+gastroscopy next month or two. It's done by a surgeon friend of mine. I always have the sedation since I trust the surgeon and I have a great gag reflex. I also find it fairly pleasant as far as the sleep and wake up goes. I just hope he uses a different oral prep. The "taste" was the single worst thing I've ever put in my mouth, let alone swallowed.

Eric

Suggest MoviPrep. It's tolerable. Rx only.

I have had 5 colonoscopy's and with every one I have had the same instructions on the oral type cleanout, Golytely and now Miralax. I have had some polyps and they were removed. Every time I was under sedation and glad of it. I woke up during one session and they were trying to make a turn in my colon and I was having super cramps before they could put me back to sleep. I'll take the Versed every time!

Jds,

Thanks - haven't heard of MoviPrep but I'm not familiar with most oral prep agents. They mailed me the prep directions so I'll see what they recommend. I wish I could recall the liquid from 5 years ago. At first I was glad it wasn't the high volume GoLytely but as soon as I drank the first sip, I almost vomited from the taste. It was very hard to describe, but some kind of extreme bitterness combined with an atrocious chemical taste. I'll post back here when I see what happens next.

Eric

Eric, I don't know if you read my post about my colonoscopy experience or not. The procedure itself was okay I guess but the prep for it was absolutely horrid. I wish I could remember what I had but I came with different flavor packets and basically a gallon jug. I started drinking this stuff. I drank about a third of it maybe. We were in the middle of a total evacuation in the nursing facility that I was working at the same time so you can only imagine the sheer hell I was going through. Anyway, a few glasses before I got the third of it in me my co-workers were either looking at me funny or commenting that I didn't look good. On one of my first trips to the bathroom I looked in the mirror and they were right, I didn't look good at all. My face was all sorts of broken out with red dots and huge red blemishes clear down my trunk. Yes, apparently I was allergic. I stopped drinking it but I was so miserable for a good 12-15 hours after that, but then the vomiting started.

As far as your sleepy time meds are concerned my best suggestion to you is to ask for Propofol and Ketamine. The two of them together are fantastic and you will not have a hang over or lose time, or anything else for that matter. I found a facility that would use both of these. As you should know, both are pretty fast acting and the propofol component is probably the safest anesthesia med available.

Mashie

Eric, I don't know if you read my post about my colonoscopy experience or not. The procedure itself was okay I guess but the prep for it was absolutely horrid. I wish I could remember what I had but I came with different flavor packets and basically a gallon jug. I started drinking this stuff. I drank about a third of it maybe. We were in the middle of a total evacuation in the nursing facility that I was working at the same time so you can only imagine the sheer hell I was going through. Anyway, a few glasses before I got the third of it in me my co-workers were either looking at me funny or commenting that I didn't look good. On one of my first trips to the bathroom I looked in the mirror and they were right, I didn't look good at all. My face was all sorts of broken out with red dots and huge red blemishes clear down my trunk. Yes, apparently I was allergic. I stopped drinking it but I was so miserable for a good 12-15 hours after that, but then the vomiting started.

As far as your sleepy time meds are concerned my best suggestion to you is to ask for Propofol and Ketamine. The two of them together are fantastic and you will not have a hang over or lose time, or anything else for that matter. I found a facility that would use both of these. As you should know, both are pretty fast acting and the propofol component is probably the safest anesthesia med available.

Mashie

Probably GoLytely. I remember the 'flavor' packets and the taste/texture combination of salt and snot. MoviPrep is so much better. Gatoraid and Mirilax is also good but can be dangerous for those of us who are prone to electrolyte imbalance due to age or renal disease.

Most of the endoscopy centers that are doing "monitored anesthesia care" or "MAC" around here are using Propofol with Fentanyl. I find that a lot of the anesthesiologists are afraid to use ketamine, as when it was used by itself in the past people sometimes didn't like the feeling they had when they were waking up. Even so, it is an extremely safe anesthetic.

Regardless, whatever they use with Propofol, it's a hell of a lot better than the stuff they used to use and no post anesthesia hangover.

The problem with MAC versus sedation is the need for an anesthesiologist or CRNA. This has significant additional costs that some insurance companies don't want to pay for.

I believe that insurance companies will eventually come around like they did with birth control medications. They finally realized that it's cheaper to give out free birth control medication than to pay all the expenses related to pregnancy and or birth, and or raising a kid.

I know a lot of people will not get a colonoscopy done if they can't be knocked out, I am one of those people. So if people stop getting the tests for prevention because it's way to painful then they end up paying potentially millions more in treatment of the things that could have been prevented or at least controlled/discovered had they had a colonoscopy to start with. The same things are happening with their views on paps and mammys, some insurance companies offer 100 percent coverage for things related to preventive medicine. They are starting to believe in the saying that we all heard growing up, " An ounce of prevention is worth a pound of cure".

Mashie

I think your impression of the insurance industry wears rose glasses. My take is that they'll find a way to minimize losses in the short term and repeat the process in the future.

Insurance companies no longer have a choice about providing 100% coverage for preventative care. It in the Affordable Care Act aka Obamacare. There is however a gaping hole. If in the course of the preventative care they find anything, for example, a tiny polyp on a colonoscopy, it isn't preventative any longer, it is a surgical procedure that they will pay a whole lot less than 100% for, and you end up with a whopping bill.

When my colonoscopies were done by a good GI man, he did his own sedation, which is common among GI docs. Several times I received 5 mg midazolam and 75 mg meperidine at which point I lost consciousness and woke up in PACU. Now it's a surgeon friend who also does his own sedation but I'm not sure what he's giving me, though it's very likely midazolam and a narcotic. I don't remember anything from his scopes either, so assuming I was breathing with a decent saturation, he's done a good job. Most non-anesthesiologists (i.e., people doing both the scope and sedation) don't want to have to pay attention enough to give propofol while also scoping, so a nice single-shot sedative like above serves them pretty well and is fairly efficient.

I may try the MoviPrep, since the prior disgusting prep stuff was to me far worse than even the large volume of GoLytely, since I could add Gatorade or something to improve the "taste."

Eric

Sedation is commonly provided under the supervision of the GI doc. That's why it costs much less. MAC requires someone trained in anesthesia and constantly monitoring you. They are prepared and trained to deliver life support as necessary. That cost is substantial.

My GI doc in NJ would do procedures in the free standing endo office if either sedation or no drugs were involved with a routine procedure. If MAC was involved, the procedure was done at the hospital - even more expensive.

Just to be clear, MAC is a buzzword invented by insurance companies to give them something to call IV "Not General Anesthesia", so they may as well have called it NAG (Not Anesthesia General) but that didn't sound so nice and/or obscure. Its the same as sedation. It's all terminology, since there's often a very thin line between sedation and GA, and if I'm doing it or a CRNA, it's billed as MAC and if by another doc like GI or Cardiology or Surgery it's billed as sedation. What they pay is dependent on billing codes. But forgetting economics and actually trying to practice decent medicine, regardless of billing or personnel or drugs used, I f the nurse in the GI or Surgery scope suite isn't monitoring you (or me next month) as closely as a true anesthesia provider, we're all screwed.

Eric

Matt, You are exactly correct, private insurance companies do in fact under Obamacare have to pay for preventative types of things and I am not exactly sure what all that includes. However if you have heard me say it once you have heard me say it a thousand times, 1) You get what you pay for, and 2) membership has it's privileges.

I have one of the Blues, and I have some of the best insurance any company offers. I know I am lucky to have such fantastic insurance, but then again, am I? I worked for it and I am paying for it out of my own pocket, and quite frankly, I deserve it.

With Obamacare yes everyone gets free preventative care. Under the same, like you said you then have to pay for the expensive surgery that is not 100 percent covered. It is partly, but not totally. Or even better you can be told to wait in line for this that and the other. With private insurance those issues are not an issue at all. Yes I have to pay a premium every two weeks, which happens to be less than 100 bucks for family coverage which covers us at a 90/10 rate, and also includes dental and vision. I know that I am very fortunate. But I am still paying for that.

So when I have a free test thanks to Obamacare, and god forbid something by chance is found, I get an immediate referral and don't have to wait in line. Then when it's all over and done with I get a bill in the mail that will range anyplace from 0 to 250 bucks perhaps depending on the test and or procedure. Private insurance is the way to go because again, membership has it's privileges, and you get what you pay for.

Mashie

Matt is 100% correct that once a polyp or anything else is found, the colonoscopy is no longer considered preventative. And, that goes for any colonoscopies that are done in the future. For example, I had a couple of polyps removed a few years ago, and because of that they want me to have another one done every 3 years or so. The next time I get one, I'm expecting that it is no longer covered as preventative, since they DID find a polyp or two in the past.

I'll echo what the others have said. I had my first one about a year ago at age 45 after my G.P. detected some blood in my stool after a DRE. The prep the night before was horrible. Stay up all night drinking vile liquid and suffering through yellow diarrhea. The procedure was not bad at all. I don't remember anything but the nurse positioning me on the table (left side, buttocks exposed) and the anesthesiologist informing me he was starting the propofol. When I came to, it was completely over. I got dressed and my wife drove me home. There's nothing kinky or fetish about it since you're out like a light.

I've had three colonoscopies. First one was kind of fun since I was given Versed and Demerol and could watch the monitor when the scope was proceeding up my colon. Second one wasn't as much fun since they didn't give me enough sedation and my colon still had some fecal matter. The third one was no problem because they put me out cold which was disappointing. I never had any pain from the procedure.

I had my usual every 3 yr. scoping yesterday. In prep. I drank the PEG solution and took 2 X 3 qt. tap water enemas Tue. and Wed nights. My rectum and descending was still dirty, but my gastro. said my transverse and ascending was clean. He actually suggested that next time I take another large volume enema the morning of the scoping. He found no polyps this time (very rare) but still wants me to be scoped every 3 years (as I agree very much). No one chewed me out about the lower prep. not being good. I may ask him next time if I can use the old time prep. of drinking 2 bottles of Mag. Citrate, then do enemas til clear. This is much easier than the PEG solution dripping all night, making my behind sore and giving e chills. I'm glad I took the extra enemas along with the PEG solution and I fasted an extra day. My G.E. understands my problem with drinking the PEG solution, since I have no sigmoid and no internal rectal sphincters and only half a rectum.

The enemas I took got all the chunky stuff out of me, so the PEG solution could concentrate on clearing my small bowel and cleaning the residue out of my large bowel. I'm glad I wore a diaper the night before the procedure, as I filled it at 3 am, stripped it off and showered. I should have done the final early morning large volume enema. Live and learn.

That first pastrami sandwich when I got home sure tasted and felt great. I slept most of the day and was very tired all Thurs. afternoon and night. I put my Klystra bag up to dry for a few days. Overall, not all that bad and I had the usual 50m. Demerol and 2 mg. Versed. A tough couple days from an extra day of fasting, but the enemas helped very much in the prep.

As a follow up to my 2011 comments. Let me just say that I am looking forward to my next Colonoscopy this January. Part of my anticipation stems from a meeting my attractive 30 something female Gastro doctor a few moths ago. During the consultation I voiced my preference for having the procedure (my fifth) without anesthesia and was pleased when she said that it would be no problem. Then she smiled and noted that she had several other patients with this preference and that it should not be that uncomfortable.

While, the fasting and oral prep is not fun, the discomfort is more than compensated by the experience. I do not mean to take away from the medical benefits of the diagnosis, nor in any way insult the professionals who perform this life saving procedure. Nevertheless, I see nothing wrong with taking enjoyment from , what is for me, great submissive anal pleasure.

Feeling that long, black, lubricated tube slithering up my colon while, at the same time, watching it on the large bedside monitor. is a unique experience. Over time, I've come to enjoy the crampy, filling sensation of my bowel being inflated to ease the passage of the instrument so much that I've added air enemas to my own self administered repertoire.

I'm drinking the bowel prep solution... 4liters of PEG.. i start drinking 90minutes ago my belly is very very big a crumpig up!!

Mashie, what you refer to as Obamacare, is private health insurance. The ACA requires health insurance companies to cover certain things, and prevents them from discriminating against those of us who have existing conditions. If your policy covers more procedures, or has a lower deductible, that is because the group you belong to is paying for it, but there is no difference between insurance purchased on the exchange, then insurance purchased off the exchange. Additionally, some companies like Humana, offer some policies that are not available on the exchange, and those policies might be cheaper but they're not eligible for any subsidies if your income qualifies you for that. I got divorced in 2000 and 6, and was told by Blue Cross and Blue Shield that they would not insure me. I then was able to get a friend of mine to add me to their companies small group, where I reimburse them for the coverage. But when that friend left her job, I had to buy my own insurance, and fortunately, the ACA was in effect and I was able to purchase it effective January 1, 2014. I will be 65 years old in October of next year, so this will be my last year requiring me to buy full care major medical insurance. But in my experience as an attorney, I have met many people, who used to buy the so-called inexpensive policies, or were insured through groups, where there was very little regulation of what was covered and what wasn't, and where out of pocket expenses were not capped. One particular client work for a municipality here in metro Atlanta, and had 70/30 co insurance. She had surgery and the bill was in excess of $200,000. Her share was $60,000. She might as well have not had any insurance, because it doesn't matter whether you bankrupt on 60000, are you bankrupt on 200000. The ACA makes a situation like that now impossible to happen again.

All I know is that Obama care is breaking the back of the middle class. My S.O. has to buy her own insurance. Before Obama care, her monthly premiums were about $130./mo. She now has the "bronze"plan (3rd one down) and has to pay a premium of $554./month. That's like a luxury car payment, or even a modest house payment every month.

This plan is killing us. If the "community organizer's" purpose is to eliminate the middle class and make us all lower class, he's doing a great job of it. We will go back to Europe in the middle ages: 1% aristocracy and 99% peasants. He told us we could keep our own doctors AND save an average of $2000/per year. Where is all this money going?

During the long stay in hospital that I'm just home from. I had numerous colonoscopies . Steven Johnson Syndrome attacks just about everywhere . I had numerous blisters internally. I was awake and alert for most of them . They were very uncomfortable . As I was being fed via NG tube I didn't really do any prep . They just stopped the feed the night before and kept Iv fluids up .

I did have one when I was under General Anasethetic but I had a few procedures done at once . I Had no after affects .

I still have GI issues from the Steven Johnson Syndrome but hopefully they will settle .

Nikki

I had my first colonoscopy perhaps 15 years ago and it saved my life because they found a tumor that was about to turn malignant. Since then I have had a few, I am not sure how many, and some of the time they have found polyps which they cut off. Based on my experience, I will say to the whole world, or at least to us zitys, get a colonoscope at least every 5 years starting at 50 unless your doctor recommends otherwise. It could save your life.

The discomfort of the prep or the invasion of your modesty are not worth your life. Remember, the people doing it see so many a day and have seen so many over the years, so they have seen it all and your particular body offers nothing new to them. For me, and I think most people, the worst part is the prep. You are anesthetised (or however you spell it) when they are actually shoving the scope into you and moving it around. The last time, I chose to be anesetised for pain relief, but awake so that I could watch the screen and see what went on. This involved not taking the Versedt. It was interesting to see what the inside of my colon looked like, and you might find it interesting, too.

hankb

I had one about 10 years ago. They blitzed me with some kind of anaethetic that had me sleeping for a week. I was a total zombie. My physician said they use something different now. I'm not real convinced, though.

Jon

Mashie,

you're right you have exceptional health insurance and a great deal of that is due to who you work for. People in healthcare are offered some of the best insurance plans out there. I know I worked for a hospital and had great insurance at a reasonable price.

I have since been disabled and unable to continue working. So my health insurance through the hospital stopped. Had it not been for Obamacare I would not have been able to get insurance (that is why I did not change jobs for the last several years that I worked because the new employers would not cover me for health insurance)

I now have private insurance that I pay a lot for that makes me jump through hoops to have my medications covered (that were covered by my plan at the hospital) and will not cover many of the tests I need because of prior diagnosis ( a colonoscopy is one of the tests not covered and is too expensive to pay for on disability). I don't need to wait for referrals but I frequently cannot afford the care offered. Obamacare is not perfect but does have some good points.

I have had several of them so far they haven't found any polyops knock on wood. Because colon cancer runs in my family. Maybe its because my use of enemas has kept me from developing it.

Had a colonoscopy last month without sedation. It was a piece of cake. Discomfort level 2 on a10 . Avoided the anesthesia fee which would have been $2000 for 15 minutes, total rip off. Got dressed and drove to work. They found nothing so I have a 10 yr pass. I wouldn't mind doing it sooner