Posted 10/18/2010 9:16 PM (GMT -8)
My positive experience with un-sedated colonoscopy today:
At my wife’s insistence I made an appointment 6 weeks ago for my first colonoscopy (50 yr old – male), left on vacation, returned and then started reading about what I’d signed up for. Lots of information on the benefits of colon cancer screening and a few stories about Versed (midazolam) – the ‘conscious sedative’ normally used in combination with Fentanyl. After researching down that path for a couple days, I concluded that the risks associated with Versed were unacceptable. I discussed this with Megan the consultation nurse (I was nervous and she was a great listener) and was told that Dr. ‘R’ was the go-to doctor at the clinic and that he had done a number of colonoscopies without sedation.
It took a couple weeks to get my head wrapped around the whole thing and be a little less nervous. I ate lightly on Saturday, then no solid food on Sunday through Monday afternoon. Sunday was a lazy day of watching football (3 games), cooking shows and a baseball playoff game. Then, MoviPrep. I suppose it’s not pronounced ‘movie’ because it’s not entertaining at all, but it is pretty effective. I followed the clinic’s suggestion – mix it ahead, add Crystal Lite Lemonade and chill. At 5:00 I chugged my first glass full followed immediately by a mouthful of warm chicken broth. Three more glasses to chug every fifteen minutes followed by another 8 glasses of clear fluids. about two hours after the first glass, it was time. Six flushes in succession, then a while later the process repeated. Things slowed down after that and I was done (except for gurglies) by 10:30.
My wife brought the potion, a glass and a mug of warm broth to me the next morning at 7:30 (she’s awesome). My knees were a little weak as I stood in front of the mirror getting ready to chug the first of another 4 glasses of this stuff. This time, it was only a one hour wait from the first glass and was done (and more comfortable – no gurglies) by 9:30. My last drink of water was at 10:30 in preparation for a 1:30 procedure.
We arrived at Camino Medical Clinic Surgi-Center at 12:30 as required for my 1:30 appointment. Walking to the front door, my wife thanked me for doing this (she was rather insistent – I think she wants me around for a while, but was also aware that I was pretty nervous). I was called in after five minutes waiting. Weight, blood pressure (138/89 – a little high, but I was nervous), and temp, then off to bed #7. “Everything off and into the bag, put on the gown", “Do I keep on my t-shirt and socks” I ask?. No, everything off, use our socks. The teal socks are cute (with little rubber feet outlines on the bottom for non-slip), but not as comfortable as mine. Oh well. I strip, gown up and wait. Now is when I wish my wife was next to me so I could hold her hand. Yep, still nervous. Breathe consciously and quietly – stop thinking.
The nurse returns a few minutes later, asks lots of medical history questions and ends with, "When was your last meal?" We go through the details of my preparation. Given my dislike of the preparation, I followed instructions to the ‘T’ – I was not going to do a go-around. I stated that I did not want sedation (ok with fentanyl, but not Versed) when she asked me to sign the sedation consent form. That stopped her for a second, so was told that the doctor would be in shortly to discuss. I approved starting the IV (for hydration) prior to my signing the consent form. The doctor arrived - he was familiar with my no-sedation request (forwarded by the consultation nurse a week prior) and had no problem, though he was clear (twice) that if he were having a colonoscopy, he would choose sedation. Not a hard sell, probably just voicing personal opinion, but….
The nurse modified the consent form to read “No medium sedation” & “No Versed – per patient” (Fentanyl falls under the ‘sedative’ protocol so we could not completely remove the sentences allowing sedation from the consent form). Sidenote: I really, really wish that this could have all been worked out and signed a week prior to my arrival. I’ve just voluntarily induced diarrhea twice in the last 12 hours, haven’t eaten in 36 hours, I’m tired and nervous. Now is NOT the time to ask me to negotiate and sign a legally binding document. Really! I sign the consent form.
I’m wheeled into the sterile room to begin the procedure.
Nurses moving around, auto-blood pressure cuff on my left arm, cannula, pulse oximiter, “Please turn on to your left side” The blanket remains on from a little above my knees to my feet, then gown is draped from the bed to my shoulder and side. I ask Dr. R. if I will get a guided tour with jokes. He stated apologetically that his jokes were stale years ago, so no jokes, but he was happy to give the tour. He explains that he’ll insert the scope and then put some air in to make room for the scope (and to see the colon walls) and that he’ll move to the end of the large intestine (the cecum) quickly and then back out slowly to inspect. He applies lube to me, then I feel as he gently inserts the scope. He explains that he’s currently in the sigmoid colon (called sigmoid because it’s ‘S’ shaped). I feel it – he’s moving back and forth little to get around – it’s not a straight line. Then I hear, “I’m in the transverse colon now”, “Really?”, I think – we’ve passed the turn from the descending colon to the transverse? I read from someone else that the turn was extremely painful for 15-20 seconds. I feel more movement inside – I suppose if I put my hand on my belly, I would feel where the scope was, but I keep my hands where they are as I focus on relaxing, anticipating pain. Cheers from the nurses and a ‘hoorah’ from Dr. R. “You’re at the cecum?” I ask? “Yes”. Two, maybe three minutes, from insertion to cecum, no pain, minimal discomfort a couple times (as he guided the scope around turns apparently). This was better than the best I’d heard about others’ experiences. This was easy. I knew from others’ accounts that the hard work was done – there was nothing else that would cause any pain.
The tour back was uneventful. As he pumped air in to keep the intestine inflated, it escaped a number of times. I figured that since he was pumping it in, it was his problem if it was coming out – there was no dignity issue. I watched as he sprayed down the colon walls a couple times to get a good view (there was a little material left, though I cannot imagine how – even Dr. R. was complimentary of what an excellent prep job I had done). We talk about what got him into this line of work (he started out in engineering school for two years), then what I do and maybe 10 minutes later, he’s done. Nurses start pulling lines, removing blood pressure cuff, pulse oximiter, cannula and I’m wheeled back to ‘recovery’.
The recovery nurse remains briefly, then leaves. Three or four minutes later Dr. R, peeks his head around the curtain, disappears, then a couple minutes later reappears. I say, “I’m ready to go – can I get the IV out and a wet wipe so I can get my butt out of here (pun intended)?” He laughs at the pun and repeats what he said during the procedure (you look great, you can eat, you can drive, have a great day and see you in 10 years). The nurse returns in another four to five minutes, removes the blood pressure cuff (I’m 122/79 I think), pulse oximiter and IV (Removing the tape holding in the IV was more painful than the procedure itself). As she’s leaving I have to ask again for something to clean up the lube with, she briefly returns with a blue towel, I hop off the bed, clean up, get dressed open the curtain, turn left and start walking, looking for the exit. The nurse is surprised by my presence, I return with her to pick up my instructions (for dealing with the amnesia caused by sedation – does not apply thank you), and the discharge nurse escorts me out.
My wife is surprised (It’s now about 1:30 – that’s the time my procedure was scheduled for) and we proceed to hamburger, fries and diet coke. We go home to eat (just in case any of that stuff is still inside me awaiting liquid to reactivate) and sit around talking about my experience (she’s due in 2 years), then head to the market to get makings for a good dinner tonight.