Colonoscopy!

[azasadny]

My experience confirms what Hugh posted. I found that if I got the "Golytely" drink very cold, it was easier to get down.

[red-beard]

Originally Posted by nostatic

Demerol and Verced is a match made in heaven. To quote an old junkie acquaintance from back in the day, "Demerol makes you feel like Jesus..."

My ex-wife had a big dose when she had some "womanly" proceedure. (I think it was a D&C...)

Anyway, her brother's wife (Diane) is a 10 watt bulb. Nicest woman in the world. Always happy and smiling. But seriously, I think she had an 85 IQ.

Anyway, my ex-wife, under Demerol, acted just like Diane. She had this great smile, crinklely smiling eyes, just wonderful. And she was soooo happy! Until it wore off. I swear, I'd still be married to her if I could have given her a lifetime supply...

[pavulon]

We sedate for all of the endo procedures at my place of work. If you like Versed and Demerol, you'd really like Versed, fentanyl and Propofol...but you're unlikely to remember the "best" parts.

Patients are instructed to not consume solids pre-procedure because those solids can coat/cake the bowel and obscure small details (like small polyps) as well as plug the scope when irrigating and suctioning irrigant or "native" fluids. The scope doesn't have wiper blades so being unable to see can make the procedure almost pointless... unless you have some large tumor or problem...which could also be missed if it looks like every other turd in there or is submerged in a puddle of "mud". Being hungry sucks but surgery and/or chemotherapy and/or hospice is even worse.

[red-beard]

Originally Posted by pavulon

The scope doesn't have wiper blades

Didn't we have a mechanical engineer looking for a senior project?

[Tobra]

Demerol can make the little old ladies start hallucinating and freak out a bit, morphine can do that too.

I think Demerol is the number one drug of abuse for healthcare workers, or I seem to remember reading that somewhere.

The junkies I have talked to about it all said that dilaudid was their favorite, after heroin of course.

Versed and the other benzos(valium, librium etc) don't do anything to my wife. Some enzyme in her blood chews it up as fast as you can give it, or that is what I am told. I saw her after getting 10 mg of versed, talking, totally clear headed. They normally give 1-2 mg. Sort of trippy to see a sub 50 kilo female get a horse dose of that stuff and it was like you gave her a glass of water.

[targa911S]

Originally Posted by Joeaksa

You guys should fly for a living! We "get the finger exam" every six months or min every year, at any age.

Need to do the "rotor rooter" exam myself, thanks for the reminder.

Joe A

My wife worked in res at Northwest for 30 years. They used to do that to her every day.

[RWebb]

the high point for me was being able to see the small nodules of bilirubin in my own tube -- too bad they can't zoom in and watch the micro-villi wave "Hi!"

when I was a grad. student my major professor was Dept. Head & after his procedure, walked into a faculty meeting with the following announcement:

"I just want everyone on the faculty here to know that I am the only administrator in this institution who has looked up his own azzhole and seen the light."

[aigel]

Only w/o anesthesia for me. Not going to be easy to find a quack to sign up for that. They'd rather have you on the table knocked out so they joke around while they root around in there ...

The major danger with the procedure is the anesthesia. I always opt out of anesthesia when possible. So far so good ...

G

[Joeaksa]

Originally Posted by pavulon

Being hungry sucks but surgery and/or chemotherapy and/or hospice is even worse.

Remember back a few years and we had a PPOT member lose his wife while doing this procedure. They went through an the wall of an intestine and she passed away several days later. Moneyguy in Tucson is the gent.

This may be a commonplace procedure, but it can still kill you. Course so can driving to and back from the clinic...

[azasadny]

When I had my scope done, they offered me a sandwich and I said "I can't eat anything, I am having surgery" and they said "it's already over". Propofol and Versed are amazing, that's all I can say! I ate my sammich and then got dressed and went home. I laid on the couch for a few hours, then went out a took the Porsche for a short drive. No pain whatsoever!

[pavulon]

If you're serious, you may want to find an endoscopist you can trust to not talk about you...or fully consider how unique your colon might or might not be.

There are folks who go at it "dry" but more than a few bail out mid procedure. If you can do the whole thing dry, I fully support you.

Originally Posted by aigel

Only w/o anesthesia for me. Not going to be easy to find a quack to sign up for that. They'd rather have you on the table knocked out so they joke around while they root around in there ...

The major danger with the procedure is the anesthesia. I always opt out of anesthesia when possible. So far so good ...

G

[RWebb]

I thought it was a nerve block?

1st time I did it w/o anything; 2nd time think I had a nerve block - not out but you are in a bit of a dream state w/ limited memory - I thus advise you to take careful notes, so you can refer to them later.

[pavulon]

well...the brain is made of neurons and is effectively blocked by medication so some may see it as a nerve block of a sort.

[artplumber]

Originally Posted by Tobra

While Peter's response is amusing, it is not accurate. This has been standard of care in US since before Ms Couric was on television.

I beg to differ (and the GI guys are making a ton of money over the difference). Screening used to be hemoccult X3 and if abnormal -> colonoscopy vs barium enema. While it is true that the GI guys tried to push this as standard, it was not considered so - HOC was the standard for screening. In fact, Flex sig was first line endo over full colonoscopy - ask the family practice guys.

Are there folks still using Demerol out there? Old drug, side effects, yuck.

[RWebb]

I don't know the exact current std. of practice but they do research on what is effective on what sub-pop'n all the time. IIRC, the fecal thing was not so great.

My understanding is that Tobra gave it to you straight.

If you do not like the std.s that the GI guys have come up with and think they are just money grubbers, you can certainly submit your own research results.

[Noah930]

Originally Posted by livi

But seriously, breakfast or not, is colonoskopy recommended as a screening investigation with asymptomatic 50 years old?

In America there's a big push for routine screening for colorectal cancer. That can include fecal occult blood testing (digital rectal exam), flexible sigmoidoscopy, and/or colonoscopy. For asymptomatic individuals it is recommended (generally--as with anything in medicine there's always debate) that screening start at age 50. Annual DRE, flex sig every 5 yrs, colonoscopy every 10 yrs. If you're symptomatic (blood in stool) or have a significant family history, then screening is recommended to start earlier (i.e. age 35).

[Noah930]

Originally Posted by porsche4life

I've always wondered what that stuff tastes like. We dispense quite a bit of it in the pharmacy.... I feel sorry for those that get it....

There are two common ways to do the bowel prep. The more traditional is with Golytely. It comes flavored (but it's kind of like bitter tonic water--not like soda), and you have to drink 3 or 4 liters of it.

Another way is with Fleets Phosphosoda. It's much smaller--maybe just a couple hundred oz. Tastes like concentrated seawater. You chase it with generous amounts of water. From personal experience I'd highly recommend chilling it prior to ingestion (for minimizing the flavor). You buy two of these, take one, and if you're pooping clear by evening skip the second. If you're still fairly "brown," you take the second bottle.

I haven't taken the Golytely, but after having prescribed both ways for many people, I'd opt for the latter (Phosphosoda) method. Of course, there's more to it than just these two fluids--you have to stop eating solid foods the day before, stay on clears the morning before the prep, then consume water to prevent dehydration during the afternoon/evening of the prep.

Having been on the driver's end of the colonoscope, I'd say it's in the patient's best interest to be as compliant as possible to minimize the technical difficulty of the procedure. When the inside of your colon is coated in green slime (that's what it looks like--not brown) it's not impossible to miss a polyp or lesion.

[Noah930]

Glad things went OK, Hugh.

[artplumber]

Originally Posted by RWebb

I don't know the exact current std. of practice but they do research on what is effective on what sub-pop'n all the time. IIRC, the fecal thing was not so great.

...
If you do not like the std.s that the GI guys have come up with and think they are just money grubbers, you can certainly submit your own research results.

Actually, it remains a debate. In fact, if you look up Annals re cost effectiveness of colonoscopy (which is not hard to do), you can find that even in that pro-colonoscopy article, they modeled every 10 year colons O/W the cost analysis would not have been so beneficial to scoping.

I did not suggest the GI docs are money grubbers, merely that they are reaping the benefit of misguided legislation.

What is the number one cause of death men and women in the industrialized world? Is it colon cancer. Is it even close?

EDIT: Noah, the prob with both preps, and anecdotally more (in my experience) with phosphosoda is electrolyte abnormalities which play havoc with guys with CV disease.

[RWebb]

OK - from my personal point of view, if the ins. co. pays for it my concern is my 20% + $1,000 (per year) + the hassle time + the thing up my butt...

are you a clinician? if so what practice area?